Impact of age and comorbidity on multimodal management and survival from colorectal cancer: A population-based study

Ilmo Kellokumpu, Matti Kairaluoma, Jukka Pekka Mecklin, Henrik Kellokumpu, Ville Väyrynen, Erkki Ville Wirta, Eero Sihvo, Teijo Kuopio, Toni T. Seppälä

Research output: Contribution to journalArticleScientificpeer-review


This retrospective population-based study examined the impact of age and comorbidity burden on multimodal management and survival from colorectal cancer (CRC). From 2000 to 2015, 1479 consecutive patients, who underwent surgical resection for CRC, were reviewed for age-adjusted Charlson comorbidity index (ACCI) including 19 well-defined weighted comorbidities. The impact of ACCI on multimodal management and survival was compared between low (score 0–2), intermediate (score 3) and high ACCI (score ≥ 4) groups. Changes in treatment from 2000 to 2015 were seen next to a major increase of laparoscopic surgery, increased use of adjuvant chemotherapy and an intensified treatment of metastatic disease. Patients with a high ACCI score were, by definition, older and had higher comorbidity. Major elective and emergency resections for colon carcinoma were evenly performed between the ACCI groups, as were laparoscopic and open resections. (Chemo)radiotherapy for rectal carcinoma was less frequently used, and a higher rate of local excisions, and consequently lower rate of major elective resections, was performed in the high ACCI group. Adjuvant chemotherapy and metastasectomy were less frequently used in the ACCI high group. Overall and cancer-specific survival from stage I-III CRC remained stable over time, but survival from stage IV improved. However, the 5-year overall survival from stage I–IV colon and rectal carcinoma was worse in the high ACCI group compared to the low ACCI group. Five-year cancer-specific and disease-free survival rates did not differ significantly by the ACCI. Cox proportional hazard analysis showed that high ACCI was an independent predictor of poor overall survival (p < 0.001). Our results show that despite improvements in multimodal management over time, old age and high comorbidity burden affect the use of adjuvant chemotherapy, preoperative (chemo)radiotherapy and management of metastatic disease, and worsen overall survival from CRC.

Original languageEnglish
Article number1751
JournalJournal of Clinical Medicine
Issue number8
Publication statusPublished - Apr 2021
Publication typeA1 Journal article-refereed


  • Colorectal cancer
  • Comorbidity
  • Elderly
  • Survival

Publication forum classification

  • Publication forum level 1

ASJC Scopus subject areas

  • Medicine(all)


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