Page 112 - Risk quantification and modification in older patients with colorectal cancer

Chapter 6
Abstract
Background: Older patients have an increased risk of morbidity and mortality after colorectal cancer (CRC) surgery. Existing CRC surgical prediction models have not incorporated geriatric predictors, limiting applicability for preoperative decision making.
The objective was to develop and internally validate a predictive model based on preoperative predictors, including geriatric characteristics, for severe postoperative complications after elective surgery for stage I-III CRC in patients ≥70 years.
Patients and methods: Prospectively collected database containing 1088 consecutive patients from five Dutch hospitals (2014-2017) with 171 severe complications (16%). Potential predictors included demographics, comorbidity, tumour location, Activities of Daily Living (ADL), history of falls, malnutrition, risk factors for delirium, use of a mobility aid and polypharmacy. The LASSO (least absolute shrinkage and selection operator) method was used for predictor selection and prediction model building. Internal validation was done using bootstrapping.
Results: A geriatric model that included gender, previous DVT or Pulmonary Embolism, COPD/Asthma/Emphysema, rectal cancer, the use of a mobility aid, ADL assistance, previous delirium and polypharmacy showed satisfactory discrimination AUC 0.69 95% CI 0.73-0.64 and optimism corrected (AUC 0.65). Based on these predictors, the 8-item Colorectal Geriatric Model (GerCRC) was developed.
Conclusion: The GerCRC is the first prediction model specifically developed for older patients planned for CRC surgery. Combining tumour and patient-specific predictors, including geriatric predictors, improve outcome prediction in the heterogeneous older population. After external validation, this risk model has the potential to be used for preoperative (shared) decision making.
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