Page 125 - Risk quantification and modification in older patients with colorectal cancer

GerCRC risk prediction model for severe complications
Strengths of our study are the reasonable sample size of high-quality prospectively collected data, the inclusion of geriatric predictors, and statistical techniques to take into account possible optimism. Limitations of our study are our model development with a relatively low number of index events. Only 16% of the patients experienced a severe complication. With 19 candidate predictors, the 10:1 ratio was exceeded, that is advocated to decrease the risk of selecting noise predictors.42 However, no previous unknown predictors were selected. We further note that self-reported physical function can be overestimated in some older patients.43
Providing accurate prognostic information to older CRC patients concerning possible risk and benefits of their surgical treatment is important because of several reasons. Prediction tools enable discussing risks of adverse treatment outcomes with potential negative effect on quality of life and physical functioning,44 and improves the likelihood that treatment decisions are consistent with their needs, values and preferences. Furthermore, they can direct alternative treatment options when available and last, when high risk populations can be identified, interventions aimed to improve surgical outcomes may become feasible. The GerCRC model has therefore good potential to be used for preoperative decision making, providing better and more accurate estimates of the risk of surgery.
Possible future research could focus on whether predictors such as physical functioning and pulmonary comorbidity such as COPD/ Asthma/Emphysema are amendable for preoperative interventions such as prehabilitation,45 pulmonary optimisation,46 and geriatric co-management47 to improve outcomes.
Conclusions
The GerCRC is the first prediction model specifically developed for older patients planned for CRC surgery. Combining tumour and geriatric predictors in the GerCRC model modestly improves performance in the heterogeneous older population. After external validation, this risk model could serve as a basis for preoperative decision making.
123
6