Challenging the age barrier: comparative outcomes in octogenarian and non-octogenarian colorectal cancer patients.

BACKGROUND: The treatment of colorectal cancer (CRC) in elderly patients, particularly in octogenarians, presents unique challenges due to comorbidities and presumed treatment intolerance. However, real-world data on outcomes in this age group remain limited. OBJECTIVE: This study aims to evaluate and compare the clinical characteristics, treatment modalities, toxicities, and survival outcomes of octogenarian CRC patients with those of younger cohorts. METHODS: In this retrospective cohort study, 111 patients diagnosed with stage I-III CRC between March 2021 and December 2023 were analyzed. Patients were stratified into three age groups: octogenarians (≥ 80 years), non-octogenarian elderly (65-79 years), and non-elderly (< 65 years). Data on demographics, comorbidities, ECOG performance status, tumor features, treatment modalities, toxicities, and survival were collected. Survival outcomes were analyzed using Kaplan-Meier and log-rank tests. RESULTS: Among the patients, 35.1% were octogenarians. Octogenarians had a significantly higher comorbidity burden but similar ECOG scores compared to younger groups. Combined local and systemic treatment was administered in 78.2% of octogenarians and was well tolerated, with comparable hematologic (15.4%) and non-hematologic (28.2%) toxicities across age groups. Disease-free survival (DFS) and overall survival (OS) were favorable in octogenarians, with 36-month OS reaching 91.8%, comparable to or slightly better than non-elderly patients (77.6%). These findings should be interpreted cautiously due to the limited sample size. The non-octogenarian elderly group demonstrated the highest survival rates overall. CONCLUSION: Octogenarians with non-metastatic CRC can achieve favorable treatment outcomes comparable to or even better than younger patients, supporting the feasibility of curative-intent treatment in this age group. Age alone should not preclude standard oncologic management in elderly CRC patients. However, the single-center design and modest sample size limit generalizability, and further multicenter validation is required.