{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T11:56:23Z","timestamp":1793706983167,"version":"4.6.1"},"reference-count":25,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"abstract":"Importance<\/jats:title>The number of older patients (80 years and older) diagnosed with locally advanced rectal cancer (LARC) is expected to increase. Although current guidelines recommend neoadjuvant chemoradiation therapy (NACRT) followed by resection, little is known about management and outcomes in this older population.<\/jats:p><\/jats:sec>Objective<\/jats:title>To assess the trends in management of older patients diagnosed with LARC who had a surgical resection.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>Patients 80 years and older who had a surgical resection for LARC were identified in the 2004-2016 National Cancer Database. Patients were grouped based on therapy sequence: (1) surgery followed by adjuvant therapy (AT), ie, chemotherapy or radiation; (2) surgery alone; or (3) NACRT followed by surgical resection. Data were analyzed in May 2021.<\/jats:p><\/jats:sec>Exposures<\/jats:title>NACRT followed by surgery, and surgery with or without AT.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Overall survival (OS) was assessed using Kaplan-Meier analyses with inverse probability of treatment weighting (IPTW) and Cox proportional hazards regression were performed to examine the association of NACRT with the risk of death.<\/jats:p><\/jats:sec>Results<\/jats:title>Of 3868 patients with LARC who underwent surgical resection, 2042 (52.8%) were male, and the mean (SD) age was 83.4 (3.0) years. A total of 2273 (58.8%) received NACRT followed by surgical resection. Factors independently associated with NACRT were more recent diagnosis, age 80 to 85 years (vs 86 years and older), fewer comorbidities, larger tumors, and node-positive disease. The Kaplan-Meier analyses with IPTW showed that 3-year and 5-year OS for NACRT (3-year: 68.9%; 95% CI, 67.0-70.8; 5-year: 51.1%; 95% CI, 49.0-53.4) vs surgery with AT (3-year: 64.4%; 95% CI, 59.0-70.2; 5-year: 43.0%; 95% CI, 37.4-49.5) vs surgery alone (3-year: 55.8%; 95% CI, 52.0-60.0; 5-year: 34.7%; 95% CI, 30.8-39.0) was significantly different (P<\/jats:italic>\u2009&amp;lt;\u2009.001). After adjusting for confounders, patients who received NACRT were more likely to undergo an R0 resection (adjusted odds ratio, 2.16; 95% CI, 1.62-2.88), which independently improved OS (P<\/jats:italic>\u2009&amp;lt;\u2009.001). Moreover, receipt of NACRT was independently associated with a 25% decreased risk of death (adjusted hazard ratio, 0.75; 95% CI, 0.69-0.82) compared with alternative treatment sequences.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>Approximately 40% of older patients with LARC did not receive the current standard of care. In this cohort, NACRT was associated with a higher likelihood of an R0 resection and improved OS. Clinicians should advocate for receipt of NACRT in older patients with LARC.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamasurg.2022.4456","type":"journal-article","created":{"date-parts":[[2022,9,28]],"date-time":"2022-09-28T15:35:44Z","timestamp":1664379344000},"page":"e224456","source":"Crossref","is-referenced-by-count":10,"title":["Treatment Utilization and Outcomes for Locally Advanced Rectal Cancer in Older Patients"],"prefix":"10.1001","volume":"157","author":[{"given":"Sean","family":"Nassoiy","sequence":"first","affiliation":[{"name":"Providence St John\u2019s Cancer Institute, Santa Monica, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wade","family":"Christopher","sequence":"additional","affiliation":[{"name":"Providence St John\u2019s Cancer Institute, Santa Monica, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Marcus","sequence":"additional","affiliation":[{"name":"Providence St John\u2019s Cancer Institute, Santa Monica, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Keller","sequence":"additional","affiliation":[{"name":"Providence St John\u2019s Cancer Institute, Santa Monica, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Weiss","sequence":"additional","affiliation":[{"name":"Providence St John\u2019s Cancer Institute, Santa Monica, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu-Ching","family":"Chang","sequence":"additional","affiliation":[{"name":"Providence Health and Services, Beaverton, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leland","family":"Foshag","sequence":"additional","affiliation":[{"name":"Providence St John\u2019s Cancer Institute, Santa Monica, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Essner","sequence":"additional","affiliation":[{"name":"Providence St John\u2019s Cancer Institute, Santa Monica, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevan","family":"Fischer","sequence":"additional","affiliation":[{"name":"Providence St John\u2019s Cancer Institute, Santa Monica, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Goldfarb","sequence":"additional","affiliation":[{"name":"Providence St John\u2019s Cancer Institute, Santa Monica, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2022,11,9]]},"reference":[{"issue":"1","key":"soi220069r1","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3322\/caac.v71.1","article-title":"Cancer statistics, 2021.","volume":"71","author":"Siegel","year":"2021","journal-title":"CA Cancer J Clin"},{"issue":"3","key":"soi220069r4","doi-asserted-by":"publisher","first-page":"145","DOI":"10.3322\/caac.v70.3","article-title":"Colorectal cancer statistics, 2020.","volume":"70","author":"Siegel","year":"2020","journal-title":"CA Cancer J Clin"},{"issue":"1","key":"soi220069r5","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/S1470-2045(20)30555-6","article-title":"Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial.","volume":"22","author":"Bahadoer","year":"2021","journal-title":"Lancet Oncol"},{"issue":"14","key":"soi220069r6","doi-asserted-by":"publisher","first-page":"980","DOI":"10.1056\/NEJM199704033361402","article-title":"Improved survival with preoperative radiotherapy in resectable rectal cancer.","volume":"336","author":"Cedermark","year":"1997","journal-title":"N Engl J Med"},{"issue":"8","key":"soi220069r7","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.1001\/jama.284.8.1008","article-title":"Preoperative radiotherapy for resectable rectal cancer: a meta-analysis.","volume":"284","author":"Camm\u00e0","year":"2000","journal-title":"JAMA"},{"issue":"9","key":"soi220069r8","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1056\/NEJMoa010580","article-title":"Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer.","volume":"345","author":"Kapiteijn","year":"2001","journal-title":"N Engl J Med"},{"issue":"17","key":"soi220069r9","doi-asserted-by":"publisher","first-page":"1731","DOI":"10.1056\/NEJMoa040694","article-title":"Preoperative versus postoperative chemoradiotherapy for rectal cancer.","volume":"351","author":"Sauer","year":"2004","journal-title":"N Engl J Med"},{"issue":"2","key":"soi220069r11","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1007\/s00268-015-3319-7","article-title":"Is chemotherapy or radiation therapy in addition to surgery beneficial for locally advanced rectal cancer in the elderly? 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