Differences in treatment and survival between elderly patients with thoracic esophageal cancer in metropolitan areas and other areas

Motoyama, Satoru; Maeda, Eri; Iijima, Katsunori; Anbai, Akira; Sato, Yusuke; Wakita, Akiyuki; Nagaki, Yushi; Fujita, Hiromu; Minamiya, Yoshihiro; Higashi, Takahiro

doi:10.1111/cas.15070

Cited by 5 publications

(6 citation statements)

References 17 publications

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“…In our study, it was found that the 5‐year survival rate of elderly patients with EC stage I was 53.4%, and the median survival time was 64 months while the 5‐year survival rate of EC stage IV was 26.5%, and the median survival time was 22 months. In our study, the 3‐year OS rate was 71.7% among Stage I patients, highly similar to 71.6% in metropolitan areas in Japan, which implies the importance for the detection and timely treatment for EC 28 . TNM staging of EC is a general comprehensive judgment of the stage in the development of EC, which integrates three indicators (Tumor size, lymph node, metastasis) that have an important impact on the prognosis of EC patients, so it is an important factor affecting the treatment and prognosis of patients with EC 5,29 .…”

Section: Discussionsupporting

confidence: 71%

“…In our study, the 3-year OS rate was 71.7% among Stage I patients, highly similar to 71.6% in metropolitan areas in Japan, which implies the importance for the detection and timely treatment for EC. 28 TNM staging of EC is a general comprehensive judgment of the stage in the development of EC, which integrates three indicators (Tumor size, lymph node, metastasis) that have an important impact on the prognosis of EC patients, so it is an important factor affecting the treatment and prognosis of patients with EC. 5,29 The earlier the tumor stage is, the higher the surgical resection rate will be, the better the treatment effect will be.…”

Section: Discussionmentioning

confidence: 99%

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The long‐term survival of esophageal cancer in elderly patients: A multi‐center, retrospective study from China

Sun

et al. 2022

Cancer Medicine

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Background: Esophageal cancer (EC) often occurs in the elderly, and approximately 40% of patients are 70 years or older. To investigate the long-term survival of esophageal cancer in elderly patients, to provide a theoretical direction for better management and predicting survival of EC based on the hospital-based multi-center study in China.Methods: The study was conducted in eighteen hospitals including 6 provincial hospitals, 8 municipal hospitals, and 4 county hospitals. We extracted information from medical record homepage, records of admission and discharge, and pathological diagnosis reports from the medical record department of the elderly patients at 70-84 years to further obtain the 3-year and 5-year overall survival (OS), and main associated factors, and to analyze the current therapeutic effect of different treatment options for elderly patients.Results: The 3-year and 5-year OS rate of the 1013 elderly patients was 44.8% and 32.8%, respectively.Their median survival was 28.00 months. The median survival of patients with squamous cell carcinoma was longer than that of other pathological type (squamous vs. other types: 31.00 vs. 20.00 months, P = 0.018). The median survival of patients with surgery only or combined therapy was longer than that of radiotherapy, chemotherapy, no therapy (surgery only vs. combined therapy vs. radiotherapy vs. chemotherapy vs. no therapy: 56.00 vs. 33.00 vs. 26.00 vs.18.00 vs. 16.00 months, P<0.001). The 5-year OS rate of patients with highly differentiated cancer was higher than that of medium differentiated and poor differentiation/undifferentiated. In multivariate analysis, the older ages, pathological stage were independent prognostic risk factors for poor EC survival. Treatment method (surgery only: HR = 0.63, 95% CI = 0.47-0.85; combined therapy: HR = 0.78, 95% CI = 0.60-1.00) was independent protective factors predictive of a good EC OS.Conclusions: The survival rate of the elderly EC patients was still low in China. Age, therapy method, and pathological stage were mainly associated with the survival rate of EC in elderly patients.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

The long‐term survival of esophageal cancer in elderly patients: A multi‐center, retrospective study from China

Sun

et al. 2022

Cancer Medicine

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“…Increased age at diagnosis and an increasing life expectancy of the population in Western countries pose a problem for the treatment of esophageal cancer in the elderly, as treatment choices are governed by comorbidities, patient performance status and patient priorities (3,4). In many landmark trials defining the role of chemoradiation in esophageal cancer, older patients have been underrepresented or excluded, making extrapolation of trial data to the elderly population problematic (5,6).…”

Section: Introductionmentioning

confidence: 99%

Chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus: Multi-center analysis on the value of standard treatment in the elderly

Bostel

Akbaba²,

Wollschläger³

et al. 2023

Front. Oncol.

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Background and purposeTo evaluate the tolerability and outcomes of chemoradiation in elderly patients with locally advanced esophageal squamous cell carcinoma (ESCC).Materials and methodsThis multi-center retrospective analysis included 161 patients with SCC of the esophagus with a median age of 73 years (range 65-89 years) treated with definitive or neoadjuvant (chemo)radiotherapy between 2010 and 2019 at 3 large comprehensive cancer centers in Germany. Locoregional control (LRC), progression-free survival (PFS), distant metastasis-free survival (DMFS), overall survival (OS), and treatment-associated toxicities were analyzed, and parameters determining patient outcomes and treatment tolerance were assessed.ResultsThe delivery of radiotherapy without dose reduction was possible in 149 patients (93%). In 134 patients (83%), concomitant chemotherapy was initially prescribed; however, during the course of therapy, 41% of these patients (n = 55) required chemotherapy de-escalation due to treatment-related toxicities. Fifty-two patients (32%) experienced higher-grade acute toxicities, and 22 patients (14%) higher-grade late toxicities. The 2-year LRC, DMFS, PFS, and OS rates amounted to 67.5%, 33.8%, 31.4%, and 40.4%, respectively. Upon multivariate analysis, full-dose concomitant chemotherapy (vs. no or modified chemotherapy) was associated with significantly better DMFS (p=0.005), PFS (p=0.005) and OS (p=0.001). Furthermore, neoadjuvant chemoradiotherapy followed by tumor resection (vs. definitive chemoradiotherapy or definitive radiotherapy alone) significantly improved PFS (p=0.043) and OS (p=0.049). We could not identify any clinico-pathological factor that was significantly associated with LRC. Furthermore, definitive (chemo)radiotherapy, brachytherapy boost and stent implantation were significantly associated with higher-grade acute toxicities (p<0.001, p=0.002 and p=0.04, respectively). The incidence of higher-grade late toxicities was also significantly associated with the choice of therapy, with a higher risk for late toxicities when treatment was switched from neoadjuvant to definitive (chemo)radiotherapy compared to primary definitive (chemo)radiotherapy (p<0.001).ConclusionsChemoradiation with full-dose and unmodified concurrent chemotherapy has a favorable prognostic impact in elderly ESCC patients; however, about half of the analyzed patients required omission or adjustment of chemotherapy due to comorbidities or toxicities. Therefore, the identification of potential predictive factors for safe administration of concurrent chemotherapy in elderly ESCC patients requires further exploration to optimize treatment in this vulnerable patient cohort.

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“…This should be a more accurate reflection of the effect of age on patients' outcome, compared with analyzing age in ranges. As in previous studies 23 , 24 , the log-rank test was used to determine the prognostic value of age with better accuracy. Furthermore, multivariate Cox regression analysis was performed to eliminate non-significant explanatory variables 6 , 16 , 25 and validate the independent prognostic value of age.…”

Section: Discussionmentioning

confidence: 99%

Influence of age as a continuous variable on survival outcomes and treatment options in patients with upper thoracic esophageal carcinoma

Ye¹,

Ye²,

Huang³

et al. 2023

J. Cancer

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Background: This retrospective review of patients with upper thoracic esophageal squamous cell carcinoma (ESCC) analyzed the prognostic value of age, as a continuous variable, and offered insight into treatment options. Methods: 568 upper ESCC patients underwent radical therapy between 2004 and 2016. Age as a continuous variable was entered into the Cox regression model with penalized spline (P-spline) analysis to investigate a correlation between age and survival outcomes. Results: Before adjustment, P-spline regression revealed U-shaped survival curves. Sixty years was the optimal cut-off age for differences in overall and progression-free survival (OS, PFS). The cohort was divided into age groups ≤ 50, 51-69, and ≥ 70 years. Multivariate analyses showed no significant differences in either PFS or OS for patients aged ≤ 50 and 51-69 years. After adjusting for covariates, P-spline regression showed that the risk of mortality and disease progression increased with age, and ≥ 70 years was an unfavorable independent prognostic factor. For age ≥ 70 years, the OS and PFS associated with non-surgery was comparable to that of surgery. For patients younger, the OS and PFS of patients given surgery was significantly better than that of patients given non-surgery. Conclusion: Age was an independent prognostic factor for upper ESCC. Patients ≥ 70 years achieved no significant survival benefit from surgery, but for those younger than 70 years surgery was the preferred treatment option.

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Differences in treatment and survival between elderly patients with thoracic esophageal cancer in metropolitan areas and other areas

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Cited by 5 publications

References 17 publications

The long‐term survival of esophageal cancer in elderly patients: A multi‐center, retrospective study from China

The long‐term survival of esophageal cancer in elderly patients: A multi‐center, retrospective study from China

Chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus: Multi-center analysis on the value of standard treatment in the elderly

Influence of age as a continuous variable on survival outcomes and treatment options in patients with upper thoracic esophageal carcinoma

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