Risk scores to predict mortality 2 and 5 years after surgery for colorectal cancer in elderly patients
Authors: González Nerea , Loroño Ane , Aguirre Urko , Lázaro Santiago , Baré Marisa , Redondo Maximino , Briones Eduardo , Sarasqueta Cristina , Bilbao Amaia , de Larrea Nerea Fernández , Quintana José María ,   for the REDISSEC-CARESS/CCR group, Quintana Jose María , Baré Marisa , Redondo Maximino , Briones Eduardo , de Larrea Nerea Fernández , Sarasqueta Cristina , Escobar Antonio , Rivas Francisco , Morales-Suárez-Varela Maria M. , Blasco Juan Antonio , del Cura Isabel , Arostegui Inmaculada , Barrio Irantzu , Bilbao Amaia , González Nerea , García-Gutiérrez Susana , Lafuente Iratxe , Aguirre Urko , Orive Miren , Martin Josune , Antón-Ladislao Ane , Torà Núria , Pont Marina , del Prado María Purificación Martínez , Loizate Alberto , Zabalza Ignacio , Errasti José , Gimeno Antonio Z. , Lázaro Santiago , Comas Mercè , Enríquez Jose María , Placer Carlos , Perales Amaia , Urkidi Iñaki , Erro Jose María , Cormenzana Enrique , Lacasta Adelaida , Piera Pep , Campano Elena , Sotelo Ana Isabel , Gómez-Abril Segundo , Medina-Cano F. , Alcaide Julia , Del Rey-Moreno Arturo , Alcántara Manuel Jesús , Campo Rafael , Casalots Alex , Pericay Carles , Gil Maria José , Pera Miquel , Collera Pablo , Espinàs Josep Alfons , Martínez Mercedes , Espallargues Mireia , Almazán Caridad , Lindenbaum Paula Dujovne , Fernández-Cebrián José María , Anula Rocío , Mayol Julio , Cantero Ramón , Guadalajara Héctor , Garceau María Alexandra , García Damián , Morey Mariel , Colina Alberto 
Published: August 2021

Abstract
Background
The aim of this study was to identify predictors of mortality in elderly patients undergoing colorectal cancer surgery and to develop a risk score.

Methods
This was an observational prospective cohort study. Individuals over 80 years diagnosed with colorectal cancer and treated surgically were recruited in 18 hospitals in the Spanish National Health Service, between June 2010 and December 2012, and were followed up 1, 2, 3, and 5 years after surgery. Sociodemographic and clinical data were collected. The primary outcomes were mortality at 2 and between 2 and 5 years after the index admission.

Results
The predictors of mortality 2 years after surgery were haemoglobin ≤ 10 g/dl and colon locations (HR 1.02; CI 0.51–2.02), ASA class of IV (HR 3.55; CI 1.91–6.58), residual tumour classification of R2 (HR 7.82; CI 3.11–19.62), TNM stage of III (HR 2.14; CI 1.23–3.72) or IV (HR 3.21; CI 1.47–7), LODDS of more than − 0.53 (HR 3.08; CI 1.62–5.86)) and complications during admission (HR 1.73; CI 1.07–2.80). Between 2 and 5 years of follow-up, the predictors were no tests performed within the first year of follow-up (HR 2.58; CI 1.21–5.46), any complication due to the treatment within the 2 years of follow-up (HR 2.47; CI 1.27–4.81), being between 85 and 89 and not having radiotherapy within the second year of follow-up (HR 1.60; CI 1.01–2.55), no colostomy closure within the 2 years of follow-up (HR 4.93; CI 1.48–16.41), medical complications (HR 1.61; CI 1.06–2.44), tumour recurrence within the 2 years of follow-up period (HR 3.19; CI 1.96–5.18), and readmissions at 1 or 2 years of follow-up after surgery (HR 1.44; CI 0.86–2.41).

Conclusion
We have identified variables that, in our sample, predict mortality 2 and between 2 and 5 years after surgery for colorectal cancer older patients. We have also created risks scores, which could support the decision-making process.

Trial registration
ClinicalTrials.gov, NCT02488161.