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Tumor location, histology predictive of bowel obstruction among elderly colon cancer patients
Elderly patients with advanced colon cancer are more likely to develop bowel obstruction with proximal, mucinous, high-grade tumors of a high nodal stage, according to recent results.
In a retrospective cohort study, researchers evaluated incidence and predictive factors of bowel obstruction (BO) among 12,553 patients aged 65 years or older with stage IV colon cancer. Data were collected from the SEER-Medicare database and dated from 1991 through 2005.
BO occurred in 1,004 patients. Hospitalization for BO occurred less frequently among those diagnosed more recently (9% of cases diagnosed between 1991 and 1995 vs. 7.1% of those between 2001 and 2005; P<.001 for trend). Older patients had BO less frequently than younger patients (10.1% of those aged 65 to 69 years vs. 5.2% of those aged 80 years or older; P<.001 for trend). Participants with obstruction at diagnosis were hospitalized for BO more frequently than those who did not (10.4% of cases vs. 7.6%; P<.001).
Investigators said patients who underwent primary tumor resection (PTR) had BO more frequently than those who did not (9.1% vs. 5.3%), but also had longer survival (median 266 days vs. 70 days; P<.001), resulting in a lower hazard of BO among PTR recipients (P<.001).
Multivariate analysis indicated associations between increased BO risk and involvement of more than three lymph nodes (HR=1.52; 95% CI, 1.26-1.84), a high tumor grade (HR=1.34; 95% CI, 1.16-1.55), mucinous histological type (HR=1.27; 95% CI, 1.08-1.5) and right-sided tumors (HR=1.22; 95% CI, 1.07-1.4). Obstruction upon cancer diagnosis also increased BO risk (HR=1.75; 95% CI, 1.47-2.04), while a more recent diagnosis decreased risk (HR=0.84; 95% CI, 0.72-0.98 for diagnosis from 2001 to 2005).
“The present study provides … the first large-scale, population-based assessment of BO in patients with stage IV colon cancer,” the researchers wrote. “Proximal tumor site, high tumor grade and mucinous histological type were associated with BO in the setting of stage IV cancer, suggesting that obstruction risk may segregate with a proximal tumor phenotype.
“Future studies will explore management and outcomes in this serious, common complication.”