Age and Colorectal Cancer Outcomes: A Comparative Analysis Between Patients Younger and Older than 70 Years

TL;DR

This study shows that age alone should not determine whether elderly colorectal cancer patients undergo surgery, as survival outcomes are comparable to younger patients when other factors are considered.

Contribution

The study demonstrates that chronological age is not an independent predictor of survival outcomes in colorectal cancer patients after surgery.

Findings

Elderly patients had earlier-stage cancers but more comorbidities and longer hospital stays.

After adjusting for confounding factors, age did not significantly affect overall or disease-free survival.

Treatment decisions should focus on individual patient health rather than age alone.

Abstract

Colorectal cancer is a major health concern worldwide, and its treatment becomes more complex as patients age. Many doctors hesitate to operate on elderly patients due to concerns about worse outcomes related to age and multiple health conditions. We studied 262 colorectal cancer patients in Brazil, comparing those under 70 years old with those 70 and older. We found that elderly patients presented with earlier-stage cancers, despite having more health problems. After surgery, their long-term survival was comparable to that of younger patients when we accounted for all relevant factors. These findings suggest that chronological age alone should not prevent elderly patients from receiving surgery. Instead, doctors should evaluate each older patient individually to determine if surgery is appropriate, rather than making decisions based solely on age. These results support a more personalized approach to treating elderly colorectal cancer patients.

Colorectal cancer is predominantly a disease of older adults, yet age-related treatment decisions remain controversial. While chronological age is often used as a criterion for surgical eligibility, it remains unclear whether age alone is an independent predictor of surgical and oncological outcomes. This study evaluated whether age is a significant determinant of outcomes in colorectal cancer patients undergoing surgical resection. This retrospective comparative study analyzed 262 patients (193 younger than 70 years, 69 aged ≥ 70 years) diagnosed with colorectal cancer stages I–IV between 2014 and 2021 at a tertiary single center. Survival analysis was conducted using Kaplan–Meier method and Cox proportional hazards regression. Elderly patients had higher ASA classification (p = 0.0270), higher hypertension prevalence (p < 0.0001), higher ICU admission rates (50.7% vs. 21.2%, p < 0.0001), and longer hospital stays (12.6 vs. 7.5 days, p = 0.0016). However, elderly patients presented with earlier-stage disease (Stage I + II: 64.2% vs. 46.1%, p = 0.0108). After adjustment for confounding factors, age did not significantly impact overall survival (HR = 1.33; 95%CI: 0.54–3.26; p = 0.5375) or disease-free survival (HR = 1.61; 95%CI: 0.79–3.29; p = 0.1939). Despite differences in clinical presentation and pathological findings, age itself was not an independent predictor of survival outcomes. These findings suggest that treatment decisions in elderly colorectal cancer patients should be informed by individual patient physiology and disease stage rather than chronological age alone.

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