Smith Grace L, Smith Benjamin D, Buchholz Thomas A, Liao Zhongxing, Jeter Melenda, Swisher Stephen G, Hofstetter Wayne L, Ajani Jaffer A, McAleer Mary F, Komaki Ritsuko, Cox James D
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, 77030, USA.
Int J Radiat Oncol Biol Phys. 2009 Jun 1;74(2):482-9. doi: 10.1016/j.ijrobp.2008.08.046. Epub 2009 Mar 14.
Optimal management of elderly patients with nonmetastatic esophageal cancer is unclear. Outcomes data after locoregional treatment are lacking for this group.
We assessed outcomes associated with standard locoregional treatments in 2,626 patients (age > 65 years) from the Surveillance Epidemiology and End Results (SEER)-Medicare cohort diagnosed with nonmetastatic esophageal cancer from 1992 to 2002. In patients treated with radiotherapy alone (RT), surgery alone (S), chemoradiotherapy (CRT), or preoperative chemotherapy followed by surgery (CRT + S), overall and disease-free survival were compared using proportional hazards regression. Postoperative complications were compared using logistic regression.
Mean age was 76 +/- 6 years. Seven percent underwent CRT + S, 39% CRT, 30% S, and 24% RT. One-year survival was 68% (CRT + S), 52% (CRT), 53% (S), and 16% (RT), respectively (p < 0.001). Patients who underwent CRT + S demonstrated improved overall survival compared with S alone (hazard ratio [HR] = 0.81; 95% confidence interval [CI], 0.66-0.98; p = 0.03) and RT (HR = 0.44; 95% CI, 0.35-0.55; p < 0.0001); and comparable survival to CRT (HR = 0.82; 95% CI, 0.67-1.01; p = 0.06). Patients who underwent CRT + S also had comparable postoperative mortality (HR = 0.96; 95% CI, 0.87-1.07; p = 0.45) and complications (OR = 0.89; 95% CI, 0.70-1.14; p = 0.36) compared with S alone.
Preoperative chemoradiotherapy may be an acceptable treatment option in appropriately selected older esophageal cancer patients. This treatment modality did not appear to increase surgical complications and offered potential therapeutic benefit, particularly compared with surgery alone.
老年非转移性食管癌患者的最佳治疗方案尚不清楚。该组患者局部区域治疗后的预后数据缺乏。
我们评估了1992年至2002年期间，监测、流行病学和最终结果（SEER）-医疗保险队列中2626例（年龄>65岁）诊断为非转移性食管癌患者接受标准局部区域治疗后的预后。在单纯放疗（RT）、单纯手术（S）、放化疗（CRT）或术前化疗后手术（CRT+S）的患者中，使用比例风险回归比较总生存期和无病生存期。使用逻辑回归比较术后并发症。
平均年龄为76±6岁。7%的患者接受CRT+S，39%接受CRT，30%接受S，24%接受RT。1年生存率分别为68%（CRT+S）、52%（CRT）、53%（S）和16%（RT）（p<0.001）。与单纯手术（S）（风险比[HR]=0.81；95%置信区间[CI]，0.66-0.98；p=0.03）和放疗（RT）（HR=0.44；95%CI，0.35-0.55；p<0.0001）相比，接受CRT+S的患者总生存期有所改善；与CRT相比生存率相当（HR=0.82；95%CI，0.67-1.01；p=0.06）。与单纯手术相比，接受CRT+S的患者术后死亡率（HR=0.96；95%CI，0.87-1.07；p=0.45）和并发症（OR=0.89；95%CI，0.70-1.14；p=0.36）也相当。
术前放化疗可能是经适当选择的老年食管癌患者可接受的治疗选择。这种治疗方式似乎不会增加手术并发症，并且具有潜在的治疗益处，特别是与单纯手术相比。
