Predictive modeling for postoperative delirium in elderly patients with abdominal malignancies using synthetic minority oversampling technique

BACKGROUND Postoperative delirium,particularly prevalent in elderly patients after abdominal cancer surgery,presents significant challenges in clinical management.AIM To develop a synthetic minority oversampling technique(SMOTE)-based model for predicting postoperative delirium in elderly abdominal cancer patients.METHODS In this retrospective cohort study,we analyzed data from 611 elderly patients who underwent abdominal malignant tumor surgery at our hospital between September 2020 and October 2022.The incidence of postoperative delirium was recorded for 7 d post-surgery.Patients were divided into delirium and non-delirium groups based on the occurrence of postoperative delirium or not.A multivariate logistic regression model was used to identify risk factors and develop a predictive model for postoperative delirium.The SMOTE technique was applied to enhance the model by oversampling the delirium cases.The model’s predictive accuracy was then validated.RESULTS In our study involving 611 elderly patients with abdominal malignant tumors,multivariate logistic regression analysis identified significant risk factors for postoperative delirium.These included the Charlson comorbidity index,American Society of Anesthesiologists classification,history of cerebrovascular disease,surgical duration,perioperative blood transfusion,and postoperative pain score.The incidence rate of postoperative delirium in our study was 22.91%.The original predictive model(P1)exhibited an area under the receiver operating characteristic curve of 0.862.In comparison,the SMOTE-based logistic early warning model(P2),which utilized the SMOTE oversampling algorithm,showed a slightly lower but comparable area under the curve of 0.856,suggesting no significant difference in performance between the two predictive approaches.CONCLUSION This study confirms that the SMOTE-enhanced predictive model for postoperative delirium in elderly abdominal tumor patients shows performance equivalent to that of traditional methods,effectively addressing data imbalance.

Influence on liver function of hepatic artery interventional chemoembolization combined reduced glutathione therapy for elderly patients with advanced liver cancer

Objective:To explore the influence on liver function of hepatic artery interventional chemoembolization combined reduced glutathione therapy for elderly patients with advanced liver cancer.Methods:A total of 120 cases of elderly patients with advanced liver cancer from digestive surgery in-patient department of our hospital during the period of January 2014 and January 2016 were selected as the research object, the patients were divided into two groups by using the random number table method,each for 60 cases.The control group were given conventional drugs chemotherapy, the study group were given hepatic artery interventional chemoembolization combined reduced glutathione therapy, serum liver function indexes of Direct Bilirubin(DBil), Total Bilirubin(TBil), Aspartate Transaminase(AST) and Alanineamino Transferase (ALT)were detected by using automatic biochemical analyzer. Results: The clinical remission rate of study group was significantly higher than the control group, the recurrence rate was obviously lower than the control group,compared between the two groups with statistically significant differences. The average survival time of study group (29.36±6.25) months, was significantly longer than the control group (18.02±4.16) months .Before the treatment, serum DBil, TBil, AST and ALT levels compared between the two groups with no statistically significant differences,after the treatment,the indexes of study group was significantly lower than the control group. The indexes levels compared between pre-therapy and post-therapy in study group with no statistically significant differences, while the indexes levels of post-therapy in the control group were significantly higher than those pre-therapy. Before the treatment, the life quality score compared between the two groups with no statistically significant differences, after treatment,the score of all patients were significantly higher than those pre-therapywhich the score of study group was significantly higher than the control group.The incidence rate of drug adverse reactions compared between the two groups with no statistically significant differences.Conclusion: The clinical efficacy of hepatic artery interventional chemoembolization combined reduced glutathione therapy for elderly patients with advanced liver cancer is satisfying, and helps to significantly improve liver function, improve life quality, it is worth popularization and application in the clinical practice.

The Process of How Elderly Patients with Lung Cancer Who Are Receiving Molecularly Targeted Therapy with Oral Agents Establish Self-Management

Purpose: In Japan, many elderly cancer patients are receiving chemotherapy using oral molecularly targeted drugs. They receive treatment in outpatient setting and have a need to self-manage at home. The purpose of this study was to clarify how elderly patients with lung cancer who are undergoing treatment with molecularly targeted drugs in outpatient setting establish self-management. Methods: The study used Kinoshita’s Modified Grounded Theory. Semi-structured interviews were conducted with 17 patients (eight males and nine females). Results: This study identified six categories: Accepting life with cancer, Maintaining activities of daily living without feeling shackled by cancer, Reconsidering how to continue being themselves in daily life until life comes to an end, Using trial and error to integrate treatment and daily living, Formulating their criteria for continuing treatment, and Obtaining help from caregivers. Conclusion: The self-management process in elderly patients consisted of maintaining treatment and integrating treatment with daily living. And they are exploring the effects of treatment and side effects in order to live their own life. Implications for Nursing: In many elderly patients with lung cancer the purpose of treatment is curative extension of survival and improved quality of life. Our findings suggest that is important we help patients to identify how patients want to live, identify ways to improve their quality of life, and share the goals of treatment between the patient and the caregiver.

Combining the Patient-Generated Subjective Global Assessment (PGSGA) and Objective Nutrition Assessment Parameters Better Predicts Malnutrition in Elderly Patients with Colorectal Cancer

Background Malnutrition is common in colorectal cancer(CRC)patients,especially in elderly patients.The Patient-Generated Subjective Global Assessment(PG-SGA)is a widely used tool developed to detect malnutrition.The aim of this study was to compare the value of the PG-SGA and objective nutrition assessment parameters,in order to identify a better predictive index for malnutrition in elderly patients with CRC.Methods A total of 131 elderly patients(age≥60 years)with CRC were included and were evaluated for their individual nutritional status using the PG-SGA.Anthropometric and serological indicators were also assayed within 48 h of admission to the hospital.Body composition analysis was implemented by bioelectrical impedance analysis(BIA)instrument.The Chi-squared test,univariate and multivariate logistic regression analysis,or Spearman’s rank correlation analysis were used to determine the differences among the above indices and parameters with regard to predicting malnutrition.Results According to the PG-SGA score,the incidence of total malnutrition in elderly patients with CRC was 80.92%(PG-SGA score≥2),which increased with age.It was found that 28%of the patients with PG-SGA classification A(PG-SGA score 0-1)had a low fat-free mass index(FFMI).Compared with those with PG-SGA A,patients with PG-SGA C PG-SGA score≥9)showed an increased neutrophil to lymphocyte ratio(NLR)and an increased platelet and lymphocyte ratio(PLR)(median=1.78 VS.2.35,P=0.015 and median=108.8 VS.141.6,P=0.001,respectively).In terms of objective nutrition assessment parameters,severely malnourished CRC patients had significantly lower values of serum albumin(ALB),and retinol conjugated protein(RBP)than those who were well-nourished[(38.35±4.84)g/L VS.(40.56±3.44)g/L,P=0.039 and(30.31±15.83)mg/L VS.(39.01±11.95)mg/L,P=0.033,respectively].The Spearman’s rank correlation analysis showed that the PG-SGA findings had positive correlations with the NLR and PLR;while it had negative correlations with the FFMI,body mass index(BMI),ALB,prealbumin,and RBP.Conclusions In clinical practice,a comprehensive nutritional diagnosis,including the PG-SGA score and these objective indicators,can avoid the underdiagnosis of malnutrition,and is more suitable to detect malnutrition(as well as its causes)in elderly patients with CRC.

Clinical outcomes of targeted therapies in elderly patients aged ≥ 80 years with metastatic colorectal cancer

BACKGROUND The 5-fluorouracil-based chemotherapy combined with oxaliplatin or irinotecan is usually used in colorectal cancer(CRC).The addition of a targeted agent(TA) to this combination chemotherapy is currently the standard treatment for metastatic CRC.However,the efficacy and safety of combination chemotherapy for metastatic CRC in patients aged above 80 years has yet to be established.AIM To assess the clinical outcomes and feasibility of combination chemotherapy using a TA in extremely elderly patients with CRC.METHODS Eligibility criteria were:(1) Age above 80 years;(2) Metastatic colorectal cancer;(3) Palliative chemotherapy na?ve;(4) Eastern Cooperative Oncology Group performance status 0-1;and(5) Adequate organ function.Patients received at least one dose of combination chemotherapy with or without TA.Response was evaluated every 8 wk.RESULTS Of 30 patients,the median age of 15 patients treated with TA was 83.0 years and that of those without TA was 81.3 years.The median progression-free survival(PFS) and overall survival(OS) in patients treated with TA were 7.4 mo and 15.4 mo,respectively,compared with 4.4 mo and 15.6 mo,respectively,in patients treated without TA.There was no significant difference in PFS(P:0.193) and OS(P:0.748) between patients treated with and without TA.Common grade 3/4 hematologic toxicities were anemia(16.7%) and neutropenia(10.0%).After disease progression,the median OS of patients who were treated with and without salvage chemotherapy were 23.5 mo and 7.0 mo,respectively,suggesting significant difference in OS(P = 0.001).CONCLUSION Combination chemotherapy with TA for metastatic CRC may be considered feasible in patients aged above 80 years,when with careful caution.Salvage chemotherapy can help improve OS in some selected of these elderly patients.

Comparison of involved-field intensity-modulated radiotherapy combined with S-1 vs radiotherapy alone for elderly patients with esophageal cancer

BACKGROUND It is estimated that about 30%of esophageal cancer(EC)patients are over 70 years old.Therefore,there is less evidence on the diagnosis and management of elderly EC patients.It is important to explore how elderly EC patients benefit from radical radiochemotherapy regimens,including the target area of radiotherapy(RT),radiation dose and fraction,and choice of chemotherapy drugs.AIM To compare the efficacy of involved-field intensity-modulated RT(IF-IMRT)combined with S-1 vs RT alone in the treatment of elderly EC patients in terms of safety,short-term response,and survival.METHODS Thirty-four EC patients aged>70 years were prospectively enrolled between December 2017 and December 2019.Based on the random number table,they were divided into an IF-IMRT+S-1 group and an IF-IMRT alone group,with 17 patients in each group.All patients were treated with IF-IMRT at a dose of 50.4-56 Gy in 28-30 fractions(1.8-2 Gy/fraction,5 fractions/wk).Oral S-1 was administered concomitantly in the IF-IMRT+S-1 group for 14 consecutive days,and a second cycle was started 7 d after drug withdrawal.After RT,4 cycles of S-1 treatment were offered as the consolidation chemotherapy.The safety,short-term response,and survival were observed after the treatment.RESULTS As of April 2022,these 34 patients had been followed up for 15.2-32.5 mo,with a median follow-up period of 24.5 mo.Complete efficacy indicators were obtained from all the patients.The objective response rate was 88.2%vs 76.5%,respectively,in the IF-IMRT+S-1 group and the RT alone group,where as the disease control rate was 100%vs 82.4%,respectively.The incidence of adverse events including grade 1-2 fatigue,granulocytopenia,thrombocytopenia,anemia,radiation esophagitis,radiation-induced skin injury,and radiation-induced lung injury was not significantly different between these two groups,so was the incidence of the grade 3 radiation esophagitis(0%vs 5.7%).The rate of progressive disease(PD)was 52.9%(n=9)in the IF-IMRT+S-1 group and 64.7%(n=11)in the RT alone group.The median progression-free survival(PFS)was 23.4 mo vs 16.3 mo,and the 2-year PFS rate was 42%vs 41.2%.The median overall survival(OS)was 27.0 mo vs 23.0 mo,and the 2-year OS rate was 58.8%vs 47.1%.Multivariate analysis showed that age was a significant prognostic factor(P=0.0019);patients aged<75 years had a significant survival advantage over patients aged≥75 years.The locations of EC also affected the prognosis.In the IFIMRT+S-1 group,the number of chemotherapy cycles was a significant prognostic factor(P=0.0125),and the risk of PD was significantly lower in EC patients who had received 6 cycles of chemotherapy than those who had received 2-5 cycles of chemotherapy.CONCLUSION Compared with IF-IMRT alone,IF-IMRT+S-1 shows the benefits of preventing PD and prolonging survival without increasing adverse reactions.Therefore,this concurrent radiochemotherapy deserves clinical application.

Decision-Making Process for the Place of Death of Elderly Patients with Advanced Cancer and Their Families

Purpose: This study aims to understand how elderly patients with advanced cancer and their families make a decision for a place of death for the patient. Methods: Semi-structured interviews were conducted with 17 pairs of elderly patients and members of their family. The patients had finished anticancer treatment and made some decision about the preferred place of death. A modified grounded-theory approach was used for the data analysis. Results: Making a “tentative” decision for the place of death of the elderly patients is a process with the core category [carefully choosing the final place for self-fulfillment]. The patients were “conducting a comprehensive review of the place of death” and “embracing the wishes for a way of life without difficulty”. Involving the family in making a “tentative” decision about the place of death of the elderly patients is the process with the core category [realizing the wish of patients in the terminal condition for the way for death]. The families were “examining the place of death from different aspects” and “respecting the patient’s intention as far as possible”. Conclusions: When the patients [carefully choosing the final place for self-fulfillment], it was important to reconcile their wishes with the burden on the families. When the families were trying to [realize the wish of patients in the terminal condition for the way for dying], it was important to balance the respect for the patient intentions and homecare they can provide for the patient. For the patients and their families, it is essential to mutually understand the intentions and wishes of the other party in decision making about the place of death.

A Multicenter Cohort Study for XELOX (Capecitabine, Leucovorin plus Oxaliplatin) Therapy as First-Line Treatment in Elderly Patients with Unresectable Colorectal Cancer

Oxaliplatin-based chemotherapy with bevacizumab is now widely used for colorectal cancer patients. This study evaluated the efficacy and tolerability of XELOX (capecitabine + oxaliplatin + leucovorin combined) therapy with or without bevacizumab in elderly patients. One hundred and seven patients, consisting of 52 elderly (>70 years of age) and 55 non-elderly, with unresectable colorectal cancer were enrolled in this multicenter cooperative group study using a database between October 2009 and March 2012. We evaluated the outcomes in terms of the median time to treat failure (TTF), overall response rate (ORR), disease control rate (DCR) and tolerability in both age groups. The median TTF for the XELOX + bevacizumab regimen was 7.1 months in the non-elderly group and 8.1 months in the elderly group (p = 0.838). There was no significant difference in TTF between the two groups. The ORR and DCR in the non-elderly group were 30.8% and 73.1%, respectively. In the elderly group, the ORR was 40.0% and the overall DCR was 90.0%. No severe or uncontrollable adverse events were observed in the two groups. These data indicated that the XELOX chemotherapy with or without bevacizumab has an equivalent efficacy in both groups, without increasing the adverse events even in the elderly population.

Treatment Patterns and Mortality Risk among Elderly Patients with Metastatic Triple Negative Breast Cancer in the United States: An Observational Cohort Study Using SEER-Medicare Data

Purpose: Triple negative breast cancer is more aggressive than other breast cancer subtypes and accounts for up to 20% of all breast cancers. Despite the poorer prognosis, there are no approved targeted treatments available and chemotherapy remains the only choice. We examined treatment patterns and outcomes among elderly metastatic triple-negative breast cancer (mTNBC) patients in routine clinical practice. Methods: Patients were identified from the linked SEER-Medicare database between 1/1/2001 and 12/31/2013 and included de novo Stage IV (n = 776) and patients with distant metastasis followed an initial diagnosis of Stage I - III disease (n = 1851). Kaplan-Meier analyses and time-varying Cox proportional hazards regression were used to assess overall survival (OS). Results: The mean age at metastatic diagnosis was 77.6 years and 1259 (48%) patients received chemotherapy. Compared to <70 year olds, ≥70 year olds had worse performance status, higher comorbidity burden, and were less likely to receive chemotherapy (45% vs. 66%). Patients treated with chemotherapy had increased OS compared to untreated patients, and the survival advantage was more pronounced in the -month longer unadjusted OS compared to the ≥70 cohort (log rank p < 0.0001). This finding was supported in the adjusted multivariate model which showed a 46% increased risk of death for untreated patients in the <70 year olds and a 17% increased risk of death for untreated patients in the ≥70 year olds (vs. treated). Conclusions: In this real-world analysis, 48% of elderly mTNBC patients did not receive chemotherapy and a greater proportion were untreated in the ≥70 year old cohort (55%). Although the survival benefits of chemotherapy were greater in the younger cohort, the benefits of treatment persisted in ≥70 year olds. These findings suggest opportunities exist to improve the clinical treatment of elderly mTNBC patients.

Multicenter Analysis of mFOLFOX6 with Oxaliplatin Stop-and-Go Strategy Using Oral Uracil-Tegafur with Leucovorin for Unresectable Colorectal Cancer in Elderly Patients

Background: This study evaluated the tolerability and efficacy of intermittent oxaliplatin treatment based on mFOLFOX6 using oral uracil-tegafur(UFT) and leucovorin(LV) maintenance therapy in the treatment of elderly patients with advanced colorectal cancer. Methods: Ten non-elderly patients (70 years) with advanced/recurrent colorectal cancer were enrolled in this prospective, multicenter cooperative group clinical trial. The mFOLFOX6 regimen was administered for eight cycles with maintenance therapy with oral UFT/LV treatment until progression. In cases with disease progression, mFOLFOX6 was reintroduced. Results: Grade 2 peripheral neuropathy was noted in 30.0% and 25.0% of the elderly and non-elderly patients, respectively. The observed time to treatment failure (TTF) was 6.3 months in the elderly patients and 6.4 months in the non-elderly patients. The disease control rate was 83.3% in each group. Conclusion: Our new stop-and-go strategy using oral UFT/LV is well-tolerated and effective even in elderly patients.

The Results Observation on Adjuvant Chemotherapy with Microwave Hyperthermia and Stereotactic Radiotherapy in Retreated Elderly Patients with Advanced (III/IV Stage) Lung Cancer

Objective: To evaluate the significance of adjuvant chemotherapy and radiotherapy (Gamma-knife) in the elderly patients with retreated advance lung cancer. Methods 83 patients (age 50 to 81 years) with retreating advanced (III/IV stage) lung cancer were divided into three groups according to patients received treating by different methods. The cases were treated by synchronous chemo-radiotherapy (A group), sequentially chemo-radiotherapy (B group) and continuous systematized chemotherapy alone (C group). The systemic 3-dimensional orientation apparatus was used in radiotherapy. The chemotherapy regimen in combined radiotherapy was given by common first line regimen on lung cancer. The regimen of chemotherapy combated with whole body hyperthermia by using micro-wave on abodeman about 2 or 3 line was used in C group only. Results: The overall responses rates (RR) of A, B and C groups were 17.1%, 11.5% and 31.8%, but it was non-significance difference (P > 0.05). Overall responses rates (RR) of III and IV stage groups were 18.2% and 20.0%. The average overall survival time (OS) and median survival time (MST) of the patients treated by chemotherapy (C group) were highest about 14.2 and 9.3 months (respectively at A group 6.7 and 6.0 months. P < 0.01), in which B group was longer than A group (P < 0.05), and 95.5% CI value was not overlap. The total survival time of postoperative patients was longer in the various groups by different treated than that in non-operations. Conclusion: The rates (RR) of III and IV stage groups were non-significance difference. The higher of ORR, OS and MST in a few patients of re-treated advanced lung cancer was presented in case with treated by continuous system chemotherapy. There were survival superiority in initial postoperative patients groups by different treated. It is a profitable and effect treatment that the pure reasonable systemic chemotherapy was used for elderly case with advanced retreated lung cancer.

Study on treatment and nursing of elderly patients with gastric cancer complicated with diabetes

Objective To study and analyze the treatment and nursing of elderly patients with gastric cancer complicated with diabetes.Methods:different data were analyzed and summarized.Conclusion:the elderly patients with gastric cancer and diabetes can cooperate with the control of blood glucose during the surgical treatment,and strengthen the nursing before and after the operation.

Preoperative selection of patients with colorectal cancerliver metastasis for hepatic resection

Surgical resection of colorectal liver metastases(CRLM) has a well-documented improvement in survival. To benefit from this intervention, proper selection of patients who would be adequate surgical candidates becomes vital. A combination of imaging techniques may be utilized in the detection of the lesions. The criteria for resection are continuously evolving; currently, the requirements that need be met to undergo resection of CRLM are: the anticipation of attaining a negative margin(R0 resection), whilst maintaining an adequate functioning future liver remnant. The timing of hepatectomy in regards to resection of the primary remains controversial; before, after, or simultaneously. This depends mainly on the tumor burden and symptoms from the primary tumor. The role of chemotherapy differs according to the resectability of the liver lesion(s); no evidence of improved survival was shown in patients with resectable disease who received preoperative chemotherapy. Presence of extrahepatic disease in itself is no longer considered a reason to preclude patients from resection of their CRLM, providing limited extra-hepatic disease, although this currently is an area of active investigations. In conclusion, we review the indications, the adequate selection of patients and perioperative factors to be considered for resection of colorectal liver metastasis.

Considerations of elderly factors to manage the complication of liver cirrhosis in elderly patients

The aging of the organ function causes sensitivity to the disease progression and need careful consideration for the medical treatment. With the increase of aging population, the opportunity to provide medical treatment for people in very old age is rapidly increasing therefore, the understanding of the various physiological changes of cellular function, size and function of organs are essential for the decision of therapeutic options. Among the various chronic conditions seen in elderly people, we have focused on liver cirrhosis, since despite specific therapeutic options for many of liver diseases including direct acting antivirals for hepatitis C virus, nucleoside analogs for hepatitis B, and corticosteroids for autoimmune hepatitis, there is currently no standard therapy to treat liver cirrhosis, which is the final stage of these liver diseases. Therefore,management of the various symptoms of liver cirrhosis is essential, and agingrelated parameters must be considered in the decision making for therapeutic strategies and dosage of the available medicine. In this mini-review, we have summarized the therapeutic options to manage various symptoms of liver cirrhosis, carefully considering the physiological changes of various organs associated with aging.

Systematic review of laparoscopic vs open surgery for colorectal cancer in elderly patients

AIM: To verify the safety and validity of laparoscopic surgery for the treatment of colorectal cancer in elderly patients.METHODS: A meta-analysis was performed of a systematic search of studies on an electronic database. Studies that compared laparoscopic colectomy(LAC) in elderly colorectal cancer patients with open colectomy(OC) were retrieved, and their short and long-term outcomes compared. Elderly people were defined as 65 years old or more. Inclusion criteria were set at: Resection of colorectal cancer, comparison between laparoscopic and OC and no significant difference in backgrounds between groups.RESULTS: Fifteen studies were identified for analysis. LAC was performed on 1436 patients, and OC performed on 1810 patients. In analyses of short-term outcomes, operation time for LAC was longer than for OC(mean difference = 34.4162, 95%CI: 17.8473-50.9851, P < 0.0001). The following clinical parameters were lower in LAC than in OC: Amount of estimated blood loss(mean difference =-93.3738, 95%CI:-132.3437 to-54.4039, P < 0.0001), overall morbidity(OR = 0.5427, 95%CI: 0.4425-0.6655, P < 0.0001), incisional surgical site infection(OR = 0.6262, 95%CI: 0.4310-0.9097, P = 0.0140), bowel obstruction and ileus(OR = 0.6248, 95%CI: 0.4519-0.8638, P = 0.0044) and cardiovascular complications(OR = 0.4767, 95%CI: 0.2805-0.8101, P = 0.0062). In analyses of long-term outcomes(median follow-up period: 36.4 mo in LAC, 34.3 mo in OC), there was no significant difference in overall survival(mean difference = 0.8321, 95%CI: 0.5331-1.2990, P = 0.4187) and disease specific survival(mean difference = 1.0254, 95%CI: 0.6707-1.5675, P = 0.9209). There was also no significant difference in the number of dissected lymph nodes(mean difference =-0.1360, 95%CI:-4.0553-3.7833, P = 0.9458).CONCLUSION: LAC in elderly colorectal cancer patients had benefits in short-term outcomes compared with OC except operation time. The long-term outcomes and oncological clearance of LAC were similar to that of OC. These results support the assertion that LAC is an effective procedure for elderly patients with colorectal cancer.

Relationship between mismatch repair protein, RAS, BRAF, PIK3CA gene expression and clinicopathological characteristics in elderly colorectal cancer patients

BACKGROUND Colorectal cancer(CRC)is common in elderly patients.Mismatch repair(MMR)protein deletion is one of the causes of CRC.The RAS(KRAS/NRAS),BRAF,and PIK3CA genes are important gene targets in CRC treatment and are closely related to the prognosis and survival of patients.However,little is known regarding the relationship between the expression of MMR,RAS,BRAF,PIK3CA and the clinicopathological features in CRC patients.AIM To analyze the relationship between the expression of MMR,RAS,BRAF,PIK3CA and the clinicopathological features in CRC.METHODS A total of 327 elderly patients with CRC were enrolled,and immunohistochemistry was used to detect the MMR protein.Real-time quantitative polymerase chain reaction was used to detect the RAS(KRAS/NRAS),BRAF,and PIK3CA genes.The clinicopathological data of the patients were recorded and analyzed by SPSS 19.0 statistical software.RESULTS In 327 elderly patients with CRC,the rate of MMR protein loss was 9.79%(32/327),and the deletion rate of four MMR proteins(MSH2,MSH6,MLH1,PMS2)was 1.83%(6/327),3.06%(10/327),7.65%(25/327),and 7.65%(25/327),respectively.There were no significant differences between MMR protein deletion and sex,pathological type,tumor morphology,differentiation degree or lymph node metastasis(P>0.05),but there was a significant difference between MMR protein deletion and tumor diameter and tumor location(P=0.048/P=0.000).The mutation rates of the KRAS,NRAS,BRAF and PIK3CA genes in elderly CRC patients were 44.95%(147/327),2.45%(8/327),3.36%(11/327)and 2.75%(9/327),respectively;the KRAS gene mutation was closely related to tumor morphology(P=0.002)but not to other clinicopathological features(P>0.05),and there were no significant differences between NRAS gene mutation and clinicopathological features(P>0.05).The BRAF gene mutation showed a significant difference in pathological type,tumor location,differentiation degree and lymph node metastasis(P<0.05),but was not correlated with sex,tumor size and tumor morphology(P>0.05).The PIK3CA gene mutation showed no significant differences in the above clinicopathological characteristics(P>0.05).Significant differences were observed between MMR protein deletion and KRAS,BRAF,and PIK3CA gene mutations in elderly CRC patients(P=0.044,P=0.000,P=0.003,respectively),but there was no significant difference between MMR protein deletion and NRAS mutation(P>0.05).CONCLUSION In elderly CRC patients,the tumor is mainly located in the right colon,and the deletion rate of MMR protein is higher when the tumor diameter is greater than or equal to 5 cm;the deletion rate of MLH1 and PMS2 is more common;the mutation rate of KRAS gene is higher than that of the NRAS,BRAF and PIK3CA genes,the BRAF gene mutation has different degrees of correlation with clinicopathological characteristics;when the MMR protein is deleted,the BRAF and PIK3CA gene mutations are often present,and the KRAS gene mutation rate is low.

Optimal management of the elderly patient with head and neck cancer: Issues regarding surgery, irradiation and chemotherapy

Head and neck cancer(HNC) represents the sixth most common malignancy and accounts for approximately 6% of new cancer cases annually worldwide. As life expectancy constantly increases, the onset of HNC in patients older than 65 years of age at diagnosis is not rare and up to one fourth of cases occurs in patients older that 70 years at age. Because elderly cancer patients are severely under-represented in clinical trials, there is a clear need to address the particular aspects of this specific patient group, especially in the context of novel multidisciplinary therapeutic approaches. The frailty of elderly patients with HNC is attributed to the high incidence of smoking and alcohol abuse in this malignancy and the presence of substantial cardiovascular, respiratory or metabolic comorbidities. In the current work, I provide an overview of current and emerging treatment approaches, in elderly patients with HNC. In particular, I discuss modern surgical approaches that improve radical excision rates while preserving functionality, the incorporation of modern radiotherapeutic techniques and the introduction of novel chemotherapeutic combinations and molecular targeted agents in an effort to reduce toxicity without compromising efficacy. Finally, there is an urgent need to increase accrual and active participation of elderly patients with HNC in clinical trials, including biomarker evaluation in biopsy specimens towards an individualized therapeutic approach.

Newly emerging standard chemotherapies for gastric cancer and clinical potential in elderly patients

With the increase in average life expectancy,the rate of occurrence of gastric cancer in elderly patients is also rising.While many clinical trials have been conducted to examine the effect of chemotherapy treatment on gastric cancer,age limits for eligible subjects have prevented the establishment of standards for chemotherapy in elderly patients with gastric cancer.As of March 2009,evidence-based standard chemotherapy regimens were established.In the Western world,debates centered on the ECF(Epirubicin/cisplatin/5FU) or DCF(Docetaxel/cisplatin/5-FU) regimens based on the phase □ randomized controlled trial at the Royal Marsden Hospital(RMH) or the V325 study,respectively.The JCOG9912 and SPIRITS trials emerged from Japan indicating attractive regimens that include S-1 for advanced gastric cancer patients.Using these active anticancer drugs,the trials that studied the eff icacy of adjuvant therapies or surgical approaches,such as the Int-116/MAGIC/ACTS-GC trials,have actually succeeded in demonstrating the benefits of adjuvant therapies in gastric cancer patients.For cases of gastric cancer in elderly patients,treatment policies should consider these studies while analyzing not only the therapeutic effects but also drug toxicity,individual general health conditions,and social factors to select treatments that emphasize quality of life.

Comparison of short-term efficacy between totally laparoscopic gastrectomy and laparoscopic assisted gastrectomy for elderly patients with gastric cancer

BACKGROUND Totally laparoscopic gastrectomy(TLG)entails both gastrectomy and gastrointestinal reconstruction under laparoscopy.Compared with laparoscopic assisted gastrectomy(LAG),TLG has been demonstrated in many studies to require a smaller surgical incision,result in a faster postoperative recovery and less pain and have comparable long-term efficacy,which has been a research hotspot in recent years.Whether TLG is equally safe and feasible for elderly patients remains unclear.AIM To compare the short-term efficacy of and quality of life(QOL)associated with TLG and LAG in elderly gastric cancer(GC)patients.METHODS The clinicopathological data of 462 elderly patients aged≥70 years who underwent LAG or TLG(including distal gastrectomy and total gastrectomy)between January 2017 and January 2022 at the Department of General Surgery,First Medical Center,Chinese PLA General Hospital were retrospectively collected.A total of 232 patients were in the LAG group,and 230 patients were in the TLG group.Basic patient information,clinicopathological characteristics,operation information and QOL data were collected to compare efficacy.Compared with those in the LAG group,intraoperative blood loss in the TLG group was significantly lower(P<0.001),and the time to first flatus and postoperative hospitalization time were significantly shorter(both P<0.001).The overall incidence of postoperative complications in the TLG group was significantly lower than that in the LAG group(P=0.01).Binary logistic regression results indicated that LAG and an operation time>220 min were independent risk factors for postoperative complications in elderly patients with GC(P<0.05).In terms of QOL,no statistically significant differences in various preoperative indicators were found between the LAG group and the LTG group(P>0.05).Compared with the laparoscopic-assisted total gastrectomy group,patients who received totally laparoscopic total gastrectomy had lower nausea and vomiting scores and higher satisfaction with their body image(P<0.05).Patients who underwent laparoscopic-assisted distal gastrectomy were more satisfied with their body image than patients in the totally laparoscopic distal gastrectomy group(P<0.05).CONCLUSION TLG is safe and feasible for elderly patients with GC and has outstanding advantages such as reducing intracorporeal blood loss,promoting postoperative recovery and improving QOL.

Primary liver cancer in the elderly: report of 125 cases

OBJECTIVES: To understand the characteristics of primary, liver camcer (PLC) in the elderly andsummarize the experience in treatment of such patients.METHODS: The clinical data of PLC in the elderly group (≥60 years, 125 patients) and the younggroup (≤59 years, 295 patients) were analyzed retrospectively.RESULTS: In the elderly group, 64 patients were found HBsAg positive, 39 patients small PLC, 24large PLC, 15 tumor emboli in the portal vein, 86 AFP positive, and 34 hepatectomy performed. In theyoung group, 205 patients were found HBsAg positive, 79 patients small PLC, 97 large PLC, 96 tumoremboli in the portal vein, 200 AFP positive, and 126 hepatectomy performed. The median survival was 44and 25 months respectively, and no significant difference was observed in the mortality between the twogroups (P】0.05).CONCLUSIONS: Hepatectomy is a choice of treatment for PLC in the elderly based on their liverfunction. AFP and B-ultrasonography are important methods for the diagnosis of PLC in the elderly.