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To evaluate the efficacy of three treatment modalities, preoperative, postoperative, and combined preoperative and postoperative systemic therapy, in elderly patients with rectal cancer (RC), and to analyze the prognostic factors for elderly RC patients.
Data from 4612 RC patients aged 60 and above were used, sourced from the SEER database between 2011 and 2015. The Overlap Weighting (OW) method based on XGBoost was employed to balance covariate differences between treatment groups and assess the impact of different treatment regimens on the survival prognosis of RC patients. Survival curves were plotted using the Kaplan-Meier method, and Log-rank tests were conducted. Cox regression analysis was utilized to evaluate independent risk factors affecting the survival of RC patients.
After OW weighting, the three treatment groups achieved balance across all covariates. The survival rates among different treatment groups were statistically significant (P<0.001). The 1-year, 3-year, and 5-year survival rates were 94.6%, 82.2%, and 71.6% for the preoperative systemic therapy group, 95.0%, 79.0%, and 67.8% for the postoperative systemic therapy group, and 97.3%, 85.5%, and 73.4% for the combined preoperative and postoperative systemic therapy group, respectively. Multivariate Cox regression analysis revealed that, compared to the preoperative systemic therapy group, the specific death hazard ratio for the postoperative systemic therapy group was 1.216(95% CI: 1.072-1.381). Patients with liver metastasis had a specific death hazard ratio of 1.719(95% CI: 1.253-2.358) compared to those without liver metastasis.
The sequence of systematic treatment has a significant impact on the survival prognosis of elderly RC patients. After controlling for factors such as age and gender, preoperative systemic treatment had a better survival prognosis among the three treatment methods; Liver metastasis may be an independent factor affecting the prognosis of RC patients.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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