Multiple colorectal cancers in the elderly: a retrospective study of both surgical and autopsy cases

Background. Multiple primary cancers are not rare events in the large intestine, and account for approximately 5–7% of patients with colorectal cancer (CRC). There are few reports demonstrating clinicopathologic features of multiple CRCs in the elderly. Methods. We clinicopathologically investigated 947 surgical patients and 362 autopsy samples from patients aged 65 years or more with CRC, including 81 surgical and 34 autopsy cases of multiple CRCs. We compared the data in the very old group (age ≥ 85 years) with those of the younger age groups, i.e., a young-old group (65–74 years) and a middle-old group (75–84 years). Results. The proportion of multiple CRCs was 8.6% (81/947) in the surgical patients and 9.4% (34/362) in the autopsy cases, with no significant difference among the three age groups. Similar site distributions and sex ratios, indicating proximal shift and female predominance with advancing age, were found in multiple and single CRCs, except for autopsy cases with multiple CRCs. Multiple CRCs in nonadjacent segments of the large intestine accounted for 11% (9/81) in surgical cases and 35% (12/34) in autopsy cases. In autopsy cases, the incidence of extracolorectal malignancies in patients with a single CRC was 22% (17/76) in the young-old group, 27% (39/147) in the middle-old group, and 35% (37/105) in the very old group, whereas the incidences in patients with multiple CRCs were 25% (1/4), 11% (2/18), and 50% (6/12), respectively. Regarding the organs with extracolorectal malignancies, the stomach (29%) was most frequent, followed by lung (14%), hematopoietic system (12%), and pancreatobiliary system (10%). Conclusions. These results indicate that the incidence of multiple CRCs in elderly patients with CRC is approximately 8%–10%, with no age-related difference, while extracolorectal malignancies increase with advancing age. Received: November 2, 2000 / Accepted: April 27, 2001     

Incidence of colorectal cancer in proctocolitis: a retrospective study of 959 cases over 40 years.

The incidence of colorectal cancer was studied by the actuarial method in 959 patients with idiopathic proctocolitis seen from 1942 to 1981. Forty five per cent had rectal, 23% left-sided, and 32% total involvement of the colon. Six cancers were found: one in the rectal, one in the left-sided, and four in the total form of the disease. The risk of cancer per patient year in total colitis was zero per 2151 patient years in the first decade, 1/462 in the second decade, 1/315 in the third decade, and 1/75 in the fourth decade. The cumulative risk of developing cancer was zero at 10 years of duration of the disease, approximately 5% at 20 years, 15% at 30 years, and 20% at 35 years. This increase in risk of cancer is less than reported in some other series. Geographical differences in the incidence of cancer in proctocolitis could influence the risk and therefore also the long-term management of patients with proctocolitis in different geographical areas.     

The colonoscopic characteristics of colorectal endometriosis: a single-centered retrospective study

正Objective To reinforce the awareness of colorectal endometriosis(EM)in colonoscopy examination.Methods Patients diagnosed as colorectal EM at Peking Union Medical College Hospital between February 2002 and February 2017 were enrolled in this study.The clinical characteristics and endoscopic features of EM lesions were summarized and compared between pathologically positive group and negative group.Results A total of 34     

Personalized surgical management of colorectal cancer in elderly population

Colorectal cancer(CRC)in the elderly is extremely common but only a few clinicians are familiar with the complexity of issues which present in the geriatric population.In this phase of the life cycle,treatment is frequently suboptimal.Despite the fact that,nowadays,older people tend to be healthier than in previous generations,surgical undertreatment is frequently encountered.On the other hand,surgical overtreatment in the vulnerable or frail patient can lead to unacceptable postoperative outcomes with high mortality or persistent disability.Unfortunately,due to the geriatric patient being traditionally excluded from randomized controlled trials for a variety of factors(heterogeneity,frailty,etc.),there is a dearth of evidence-based clinical guidelines for the management of these patients.The objective of this review was to summarize the most relevant clinical studies available in order to assist clinicians in the management of CRC in the elderly.More than in any other patient group,both surgical and non-surgical management strategies should be carefully individualized in the elderly population affected by CRC.Although cure and sphincter preservation are the primary goals,many other variables need to be taken into account,such as maintenance of cognitive status,independence,life expectancy and quality of life.     

大肠息肉部位、大小、形态等与病理分型的关系

目的探讨大肠息肉部位、大小、形态、数目部与病理类型的关系。方法经结肠镜检查诊断200例结肠息肉情况与病理检查进行分析。结果在≤1cm的息肉中以炎性息内较多见，在〉lcm的息肉中以腺瘤性息肉较多见。息肉恶变均发生在1cm以上，尤其是〉2cm的息肉。在有蒂息肉中以炎性较多见，均为良性，无蒂息肉中以腺瘤性较多见。最常发生于直肠和乙状结肠的息肉以炎性较多见；近端结肠的息肉，腺瘤性相对较多。单发息肉中多数是炎性息肉，多发息肉中多数是腺瘤性息肉。结论大肠息肉的部位和大小与病理类型有关。     

Poor prognosis of young patients with colorectal cancer: a retrospective study

Purpose

The present study aimed to explore the survival outcomes of patients with colorectal cancer (CRC) aged 35 years and younger.

Methods

This retrospective cohort study included a total of 995 patients with CRC treated between January 2003 and September 2011. The patients were assorted into the young (aged 18–35 years) and older (aged 36–75 years) groups. The clinical characteristics and survival outcomes of the patients in the young group were compared with those of the patients in the older group for evaluation.

Results

Compared with the older group, a significantly higher number of patients in the young group had right-sided colon cancer (30.9 vs. 19.6%, P = 0.026), high histologic grade tumor (14.7 vs. 6.4%, P = 0.021), and stage III disease (50.0 vs. 35.5%, P = 0.016). In stage III disease, compared with the older group, the patients in the young group had worse survival outcome in terms of 5-year overall survival (OS, P = 0.007), cancer-specific survival (CSS, P = 0.010), and disease-free survival (DFS, P = 0.039). Multivariate analysis revealed that age ≤35 years was an independent risk factor in terms of 5-year OS (hazard ratio [HR] = 1.68; 95% confidence interval [CI]: 1.12–2.54; P = 0.012), CSS (HR = 1.74; 95% CI: 1.15–2.65; P = 0.009), and DFS (HR = 1.58; 95% CI: 1.06–2.35; P = 0.024).

Conclusions

The young patients with CRC aged 35 years and younger had worse prognosis compared with older patients, especially for stage III disease.

     

昆明地区结直肠肿瘤260例

目的:分析单中心收治的结直肠肿瘤患者的临床特点,为临床诊治提供参考.方法:回顾分析我院2010年经外科手术确诊的260例原发性大肠肿瘤患者临床资料,探讨确诊大肠肿瘤临床特点及其与吸烟、饮酒和既往病史等可能影响其发生发展的因素的关系.结果:大肠肿瘤患者的男女比例为1.24∶1,平均年龄61.73岁±11.56岁.好发部位依次为直肠、乙状结肠、升结肠、横结肠和降结肠,同时性多发癌8例.64.23%的直肠肿瘤距肛门≤8cm,男性直肠肿瘤距肛门的距离(8.22cm±3.35cm)明显大于女性(7.08cm±2.09cm,t=2.20,P=0.03).直肠和左半结肠以大便带血为主,右半结肠以腹痛腹胀为主,大便潜血阳性率为80.43%.DukesA期比例升至18.85%,分化程度和年龄负相关(r=-0.145,P=0.019).胆囊切除术后患者右半结肠肿瘤比例高(P>0.05),高血压病史患者器官转移比例低(P<0.05).结论:直肠指诊和大便隐血实验是重要的检查方法;大便带血和腹胀腹痛分别是左半结肠、直肠和右半结肠的主要症状;大肠肿瘤早期诊断率呈增高趋势;年龄、胆囊切除术和高血压病可能是影响大肠肿瘤发生发展的因素.     

Sarcoidosis diagnosed in elderly subjects: retrospective study of 30 cases

STUDY OBJECTIVE: This study investigated the clinical features and disease course of sarcoidosis diagnosed in patients > 70 years of age. METHODS: A retrospective analysis was made of cases treated at the University Hospital in Nantes, France, between 1986 and 2000. The diagnosis of sarcoidosis was confirmed histopathologically. Cases involving progressive cancer and active tuberculosis were excluded. RESULTS: Thirty white patients with sarcoidosis diagnosed after age 70 years (mean, 74 years) were included. An alteration of general health (asthenia and/or anorexia and/or weight loss) was frequent (53%) and characteristic of the systemic form of the disease. Dyspnea was a fairly common sign (23%). The intrathoracic form of sarcoidosis was most frequent (43.3%). Diagnosis was difficult and lengthy, and symptomatology was atypical. Accessory salivary gland biopsy was an important contributing factor to diagnosis (70.6% were positive). Oral corticosteroid therapy was often required (60.7%). The disease course was satisfactory overall (81.8% of cases), but only for 50% of patients in intrathoracic stage IV. CONCLUSIONS: The clinical presentation of sarcoidosis in elderly subjects is mainly characterized by an alteration of general health. Diagnosis is difficult and should include accessory salivary gland biopsy. Therapy frequently involves corticosteroids. Overall prognosis is similar to that for young subjects.     

Prognostic factors in node-negative colorectal cancer: a retrospective study from a prospective database

Purpose  

There is a need to identify a subgroup of high-risk patients with node-negative colorectal cancer who have a poor long-term prognosis and may benefit from adjuvant therapies. The aim of this study was to evaluate the prognostic impact of clinical and pathological parameters in a retrospective study from a prospective, continuous database of homogenously treated patients.     

Clinical characteristics and prognosis of elderly patients with colorectal cancer: Comparison between surgical resection and supportive care

Elderly colorectal cancer (CRC) patients tend to avoid standard treatment, especially curative surgical resection, because of concerns about surgical complications or underlying diseases. This study is intended to compare clinical characteristics and prognosis between patients who had undergone surgical resection and received supportive care, and to evaluate the usefulness of surgical treatment in elderly patients.A total of 114 patients aged ≥80 years who were diagnosed with CRC were analyzed retrospectively. Of these patients, 73 patients underwent surgical resection for malignancy and 41 patients received supportive care. Clinicopathological factors and overall survival (OS) rates were compared.The surgical resection group had better Eastern Cooperative Oncology Group performance status, American Society of Anesthesiologists (ASA) physical status, and a lower stage than did the supportive-care group. The 3-year OS rate of the surgical group was significantly higher than that of the supportive-care group (60.7% vs 9.1%, P < .001). In extremely elderly patients (age ≥85 years), the surgical group showed a better 3-year OS rate than did the supportive-care group (73.9% vs 6.3%, P < .001), although Eastern Cooperative Oncology Group performance status and ASA physical status were not different. The post-operative mortality rate was 2.7%. In the analysis of risk factors related to survival, surgical resection was a good prognostic factor.Surgical treatment in elderly CRC patients showed a survival benefit, even in the extremely elderly patients. Surgical resection for CRC in elderly patients can be considered to improve survival.     

Duodenal ulcer disease in the elderly: a retrospective study

A retrospective study was performed of 163 patients aged 65 years and over with a diagnosis of duodenal ulceration admitted to one Health District over a period of six years. Eighty per cent of the patients were admitted with acute complications, 50% bled and 30% were perforated. A large proportion of these patients were currently taking anti-inflammatory agents. Patients managed surgically for their complications had a high mortality rate but this was even higher for those managed conservatively. Giant ulcers were found to occur frequently in this age group which had a tendency to severe bleeding. It is concluded that early diagnosis and prompt surgical intervention is essential in the management of complications associated with duodenal ulceration in the elderly.     

Pathologic ventricular hypertrophy in the offspring of diabetic mothers: a retrospective study.

AIMS: Diabetes in pregnant women is increasing and with that the complications in their offspring. We studied our population of diabetic mothers (2003-2005) for pathologic ventricular hypertrophy (PVH). METHODS AND RESULTS: In our retrospective study of all 87 diabetic pregnancies (92 neonates), 16 were type 1, 17 were type 2, and 54 were gestational diabetes (GD). Haemoglobin glycated (HbA1c) median was 5.8% (5.3-6.5): 17 with HbA1c above normal 2 with congenital heart disease (CHD) and six with PVH. A total of 75 neonates were normal, five had CHD, and 12 had PVH (1/12 died post-natally, 1/12 stillborn, 2/12 required premature delivery, 8/12 normal). The 16 type 1 pregnancies resulted in three neonates with CHD and in 50% PVH, including one death, one premature Cesarean section because of PVH. The 17 neonates of type 2 pregnancies showed in one CHD and in 25% PVH. Of the 54 GD pregnancies, one had CHD and one had PVH. CONCLUSION: Pregnancies of both type 1 and 2 diabetes carry an increased risk for foetal development of PVH compared with those with GD. The insufficient effect of preventive glycaemia controls leads to conclude that although no definite predictive parameters for malignant outcome can be presented, close monitoring of these pregnancies may prevent perinatal catastrophes.     

胰腺癌513例神经浸润的病理分析

目的 探讨胰腺癌神经浸润的特征及其与其他临床病理参数之间的关系.方法 光镜下观察491例胰腺导管腺癌、22例其他胰腺恶性肿瘤、41例胰腺良性病变和21例慢性胰腺炎组织中的神经浸润状况,分析其与其他病理学指标的相关性.结果 胰腺导管腺癌的神经浸润率为74%,显著高于其他类型恶性肿瘤的23%(P＜0.01).导管腺癌癌细胞通常穿越外周神经中膜到达内部的神经纤维束,有的甚至横断整根神经纤维.但神经浸润与导管腺癌的分化程度无关.52%的胰腺导管腺癌癌旁组织呈慢性炎症改变,且程度严重,远高于其他类型胰腺癌(14%)及胰腺良性病变(15%)的慢性炎症发生率(P＜0.01).胰腺导管腺癌淋巴细胞浸润神经的发生率为65%,远高于其他恶性肿瘤的36%和胰腺良性病变的22%(P＜0.01).胰腺导管腺癌的神经浸润与癌旁慢性胰腺炎症以及淋巴细胞浸润神经均相关,但与淋巴结转移无关.结论 神经浸润是胰腺导管腺癌特征性的生物学行为之一.     

Comparison between surgical outcomes of colorectal cancer in younger and elderly patients

AIM:To compare the outcome of surgical treatment of colorectal adenocarcinoma in elderly and younger patients.METHODS:The outcomes of 122 patients with colorectal adenocarcinoma who underwent surgical treatment between January 2004 and June 2009 were analyzed.The clinicopathological and blood biochemistry data of the younger group(<75 years) and the elderly group (≥75 years) were compared.RESULTS:There were no significant differences between the two groups in operation time,intraoperative blood loss,hospita...     

Acute appendicitis in the elderly: a 5-year retrospective study

Acute appendicitis in elderly patients has not been studied extensively in the United Kingdom. Studies were performed prior to the regular use of broad spectrum antibiotics and tended to include younger patients. We studied retrospectively all elderly patients (n = 30, mean age = 72 years) who presented in the years 1980-85 and a younger group (n = 30, mean age = 23 years) who had a confirmed pathological diagnosis of appendicitis. We found a significant reduction in accurate pre-operative diagnoses, a longer duration of hospital stay and increased complication and mortality rates in the elderly group. Our study suggests that diagnostic accuracy, mortality and morbidity have not improved in comparison to earlier overseas studies.     

Colonoscopy overuse in colorectal cancer screening and associated factors in Argentina: a retrospective cohort study

Background

In recent years, there has been growing concern about the overuse of colonoscopy (CC). Our objective was to evaluate the incidence rate and cumulative probability of having a potentially inadequate CC (PI-CC, e.g. a CC that was performed earlier that recommended) and the association between the report of a hyperplastic polyp in the baseline CC report and the probability of having a PI-CC.

Methods

A retrospective cohort of adults 50y/o or older with a complete baseline CC between January 1st and December 31st 2005, without reported lesions or with hyperplastic polyps, based on secondary data extracted from the electronic medical record of the Hospital Italiano of Buenos Aires. The outcome consisted of time until a PI-CC, defined as the time measured between basal colonoscopy and a colonoscopy performed earlier than the inter-screening interval recommended by the USPSTF and the USMSTF.

Results

389 patients were included. The cumulative probability of receiving a PI-CC over 10 years was 0.29 (95% CI 0.241, 0.342). The incidence rate resulted in 30.91 PI-CC per 1000 person-years (95% CI 25.14, 38). The crude analysis of the association between the outcome and the presence of hyperplastic polyps in the baseline CC, showed a statistically significant difference between both groups (log rank, p 0.036). The multivariate analysis yielded a hazard ratio of 1.67 (95% CI 1.02–2.73).

Conclusion

We observed that 3 in every 10 patients treated in our health system received a PI-CC during the first ten consecutive years after a normal complete CC. Furthermore, this could be in part attributed to the presence of a hyperplastic polyp in the baseline CC.

     

老年人大肠癌内镜诊断和临床特征分析

目的 探讨老年人大肠癌的发病特点、内镜下表现、临床特点及其预后。方法回顾复旦大学附属华东医院2000～2007年间，总计18041例结肠镜检查结果，经结肠镜及病理证实的大肠癌患者有811例，其中老年组（≥60岁）565例，中位年龄73．19岁，复习内镜下表现，分析其临床特点，并与非老年组（〈60岁）作对比分析。结果大肠癌的发病率随着年龄的增加而升高，男女发病率差异无统计学意义。两组均以便血、腹痛、大便习惯改变等为主要症状，老年组贫血和便秘发生率高于非老年组；而腹痛和便血发生率低于非老年组。内镜下老年人大肠癌以肿块型最多见，直肠和乙状结肠仍是好发部位，老年组病例大肠癌的发生率为34．05％，高于非老年组。老年人大肠癌以中、高分化腺癌为主，预后较好。早期癌预后好，同时癌预后差。结论老年人是大肠癌的高危人群，对临床疑诊大肠癌者，应尽早行结肠镜检查。结肠镜检查是早期诊断老年人大肠癌最安全、有效的方法。     

The incidence of post-colonoscopy colorectal cancer: a retrospective long-term cohort study using a colonoscopy database

Purpose

The cumulative incidence of post-colonoscopy colorectal cancer remains unclear. Our aims were to estimate the incidence of and identify risk factors associated with post-colonoscopy colorectal cancer.

Methods

We conducted a retrospective cohort study using the colonoscopy database of the Department of Gastroenterology, the University of Tokyo Hospital Records from1995–2012. A cohort of 2544 patients, who received multiple colonoscopies without colorectal cancer findings at first colonoscopy, was selected. The primary outcome was post-colonoscopy colorectal cancer; data were censored at the date of final colonoscopy. We assessed patients’ background characteristics, colonoscopy findings, and cancer characteristics, including location and size. The cumulative incidence of colorectal cancer was evaluated, and a Cox proportional hazards model was used to estimate hazard ratios (HRs).

Results

Colorectal cancer was identified in seven (0.77/1000 person-years) patients during the mean follow-up period of 3.6 years (maximum, 17 years). The cumulative incidence of colorectal cancer was 0, 0.47, 0.62, and 0.62% at 1, 5, 10, and 15 years, respectively. Cancer was identified in the rectum in five of seven patients. Polyp size >10 mm (HR 5.7, p = 0.023) and intubation time >30 min (HR 11.6, p = 0.003) at first colonoscopy were associated significantly with an increased incidence of post-colonoscopy colorectal cancer.

Conclusions

Although several factors were associated with an increased risk of post-colonoscopy colorectal cancer, the incidence of this disease might be low in patients who received at least twice colonoscopy. High proportion of rectal cancer in post-colonoscopy colorectal cancer should be noted.

     

Acute nonlymphocytic leukemia in the elderly: results of a retrospective study

Seventy-four patients over 60 years of age with new cases of ANLL diagnosed between January, 1980 and December, 1986 were retrospectively evaluated. Twenty-nine (median age 63, range 60-70) received aggressive induction polychemotherapy: 15 achieved CR (52%), 10 were resistant (34.5%) and 4 died during induction (13.5%). Overall median survival was 6 1/2 months, median CR duration and median survival of responders were 9 and 13 months, respectively. Eight patients (median age 70.4, range 64-74) received low doses of Ara-C: 2 achieved CR, 5 were resistant and 1 died during induction, with an overall median survival of 6 1/2 months; 37 patients (median age 72, range 60-86) received only supportive care and cytostatic therapy for disease control with Hydroxyurea and 6-Mercaptopurine if WBC greater than 20 x 10(9)/l: overall median survival was 6 months and 2 patients are still alive after 18 and 26 months. Aggressive chemotherapy seems to be the treatment of choice in patients less than or equal to 70 years, while for those over 70 current supportive care may offer good survival and a good quality of life.