Skip to main content
SpringerLink
Log in

Survival benefit of adjuvant chemotherapy in elderly patients with colon cancer: a systematic review and meta-analysis

  • Original Article
  • Published:
International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Background

Adjuvant chemotherapy after curative resection is established as a standard therapy for colon and rectal cancer. Although the efficacy of adjuvant chemotherapy has been shown by pooled analyses from randomized controlled trials, elderly patients still receive adjuvant chemotherapy less frequently than younger patients. In this systematic review and meta-analysis, we aimed to assess the survival benefit of adjuvant chemotherapy in elderly patients based on observational studies in which the elderly patients would likely be representative of those encountered in real-world clinical settings.

Methods

A comprehensive literature search was conducted using PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. Observational studies that investigated the survival benefit of adjuvant chemotherapy after curative resection in elderly patients (age ≥ 70 years) with colon or rectal cancer were included. The 5-year overall survival (OS) rate and OS were assessed. Risk of bias was assessed using the ROBINS-I tool.

Results

Eleven studies in elderly patients with colon cancer were included. No relevant study was identified for rectal cancer. Elderly patients who received adjuvant chemotherapy had a significantly higher 5-year OS rate than those who did not (risk ratio 1.51, 95% confidence interval 1.29–1.76, P < 0.001). There was also a significant improvement in OS in elderly patients who received adjuvant chemotherapy (hazard ratio 0.59, 95% confidence interval 0.53–0.66, P < 0.001). The overall risk of bias was judged to be critical for both outcomes.

Conclusion

Adjuvant chemotherapy provides a survival benefit for elderly patients with colon cancer, although the quality of evidence is low.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Hashiguchi Y, Muro K, Saito Y et al (2020) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol 25:1–42

    Article  Google Scholar 

  2. Benson AB 3rd, Schrag D, Somerfield MR et al (2004) American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol 22:3408–3419

    Article  Google Scholar 

  3. Chau I, Cunningham D (2006) Adjuvant therapy in colon cancer–what, when and how? Ann Oncol 17:1347–1359

    Article  CAS  Google Scholar 

  4. Millan M, Merino S, Caro A et al (2015) Treatment of colorectal cancer in the elderly. World J Gastrointest Oncol 7:204–220

    Article  Google Scholar 

  5. Hoshino N, Kawada K, Hida K et al (2017) Impact of venous invasion on the efficacy of adjuvant chemotherapy in elderly patients with stage III colorectal cancer. Med Oncol 34:138

    Article  Google Scholar 

  6. Nitsche U, Stöss C, Friess H (2017) Effect of adjuvant chemotherapy on elderly colorectal cancer patients: lack of evidence. Gastrointest Tumors 4:11–19

    Article  CAS  Google Scholar 

  7. Sterne JA, Hernán MA, Reeves BC et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919

    Article  Google Scholar 

  8. Bergquist JR, Thiels CA, Spindler BA et al (2016) Benefit of postresection adjuvant chemotherapy for stage III colon cancer in octogenarians: analysis of the national cancer database. Dis Colon Rectum 59:1142–1149

    Article  Google Scholar 

  9. Hoeben KW, van Steenbergen LN, van de Wouw AJ et al (2013) Treatment and complications in elderly stage III colon cancer patients in the Netherlands. Ann Oncol 24:974–979

    Article  CAS  Google Scholar 

  10. Kim KY, Cha IH, Ahn JB et al (2013) Estimating the adjuvant chemotherapy effect in elderly stage II and III colon cancer patients in an observational study. J Surg Oncol 107:613–618

    Article  Google Scholar 

  11. Ko JJ, Kennecke HF, Lim HJ et al (2015) Reasons for underuse of adjuvant chemotherapy in elderly patients with stage III colon cancer. Clin Colorectal Cancer 15:179–185

    Article  Google Scholar 

  12. Lee KY, Park JW, Cho S et al (2019) Adjuvant chemotherapy does not provide survival benefits to elderly patients with stage II colon cancer. Sci Rep 9:11846

    Article  Google Scholar 

  13. Sanoff HK, Carpenter WR, Stürmer T et al (2012) Effect of adjuvant chemotherapy on survival of patients with stage III colon cancer diagnosed after age 75 years. J Clin Oncol 30:2624–2634

    Article  Google Scholar 

  14. Tsai T-C, Sun J-L, Lin W-L et al (2018) Survival of adjuvant chemotherapy among elderly patients with stage II colon cancer. Int J Gerontol 12:94–99

    Article  Google Scholar 

  15. van Erning FN, Janssen-Heijnen ML, Creemers GJ et al (2017) Recurrence-free and overall survival among elderly stage III colon cancer patients treated with CAPOX or capecitabine monotherapy. Int J Cancer 140:224–233

    Article  Google Scholar 

  16. van Steenbergen LN, Lemmens VEPP, Rutten HJT et al (2012) Increased adjuvant treatment and improved survival in elderly stage III colon cancer patients in The Netherlands. Ann Oncol 23:2805–2811

    Article  Google Scholar 

  17. Carrato A (2008) Adjuvant treatment of colorectal cancer. Gastrointest Cancer Res 2:S42-46

    PubMed  PubMed Central  Google Scholar 

  18. Twelves C, Wong A, Nowacki MP et al (2005) Capecitabine as adjuvant treatment for stage III colon cancer. N Engl J Med 352:2696–2704

    Article  CAS  Google Scholar 

  19. Lieu C, Kennedy EB, Bergsland E et al (2019) Duration of oxaliplatin-containing adjuvant therapy for stage III colon cancer: ASCO clinical practice guideline. J Clin Oncol 37:1436–1447

    Article  CAS  Google Scholar 

  20. Sargent DJ, Goldberg RM, Jacobson SD et al (2001) A pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients. N Engl J Med 345:1091–1097

    Article  CAS  Google Scholar 

  21. McCleary NJ, Meyerhardt JA, Green E et al (2013) Impact of age on the efficacy of newer adjuvant therapies in patients with stage II/III colon cancer: findings from the ACCENT database. J Clin Oncol 31:2600–2606

    Article  CAS  Google Scholar 

  22. Haller DG, O’Connell MJ, Cartwright TH et al (2015) Impact of age and medical comorbidity on adjuvant treatment outcomes for stage III colon cancer: a pooled analysis of individual patient data from four randomized, controlled trials. Ann Oncol 26:715–724

    Article  CAS  Google Scholar 

Download references

Acknowledgement

This systematic review was supported by a grant from the Mitsubishi Foundation (ID: 30327).

Author information

Authors and Affiliations

  1. Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Nobuaki Hoshino, Ryuhei Aoyama & Koya Hida

Authors
  1. Nobuaki Hoshino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ryuhei Aoyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Koya Hida
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nobuaki Hoshino.

Ethics declarations

Conflict of interest

The authors declare no conflict of interests for this systematic review.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 19 KB)

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hoshino, N., Aoyama, R. & Hida, K. Survival benefit of adjuvant chemotherapy in elderly patients with colon cancer: a systematic review and meta-analysis. Int J Clin Oncol 26, 883–892 (2021). https://doi.org/10.1007/s10147-021-01858-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10147-021-01858-3

Keywords

Search

Navigation