Abrams Julian A, Buono Donna L, Strauss Joshua, McBride Russell B, Hershman Dawn L, Neugut Alfred I
Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA.
Cancer. 2009 Nov 1;115(21):4924-33. doi: 10.1002/cncr.24536.
: Esophagectomy has been the traditional treatment of choice for early stage esophageal cancer. However, esophagectomy is associated with high mortality and morbidity in the elderly, and these patients often receive chemoradiation instead. The authors of this report compared outcomes of esophagectomy versus chemoradiation in a population-based sample of elderly patients with early stage esophageal cancer.
: The Surveillance, Epidemiology, and End Results-Medicare database was used to identify patients aged > or =65 years who were diagnosed with stage I or II esophageal cancer from 1991 to 2002. The associations of treatment with esophagectomy or chemoradiation were assessed along with demographic and clinical variables. A survival analyses was performed to compare outcomes with treatment modality and was adjusted for potential confounders.
: Seven hundred thirty patients with stage I or II esophageal cancer were identified who underwent esophagectomy (n = 341; 46.7%) or chemoradiation (n = 389; 53.3%). Older age, squamous cell histology, and lower socioeconomic status were associated with increased odds of receiving chemoradiation. In multivariate analyses, chemoradiation was associated with worse disease-specific survival (hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.64-2.64) and overall survival (HR, 1.92; 95%CI, 1.58-2.34). The receipt of chemoradiation was associated with worse survival for patients with adenocarcinoma (HR, 3.01; 95%CI, 2.24-4.04), but there was no significant difference for patients with squamous cell carcinoma (HR, 1.33; 95%CI, 0.98-1.80).
: Compared with chemoradiation, esophagectomy may be associated with improved survival for early stage esophageal cancer in the elderly. The current results suggest that there also may be a subset of patients with squamous cell carcinoma for whom chemoradiation is adequate therapy. A randomized trial would be useful to determine the optimal treatment for elderly patients with early stage esophageal cancer. Cancer 2009. (c) 2009 American Cancer Society.
食管切除术一直是早期食管癌的传统首选治疗方法。然而，食管切除术在老年患者中与高死亡率和高发病率相关，因此这些患者常接受放化疗。本报告的作者比较了基于人群样本的老年早期食管癌患者接受食管切除术与放化疗的疗效。
利用监测、流行病学和最终结果-医疗保险数据库，识别出1991年至2002年期间年龄≥65岁、被诊断为I期或II期食管癌的患者。评估了食管切除术或放化疗治疗与人口统计学和临床变量之间的关联。进行了生存分析以比较不同治疗方式的疗效，并对潜在混杂因素进行了校正。
共识别出730例I期或II期食管癌患者，其中341例（46.7%）接受了食管切除术，389例（53.3%）接受了放化疗。年龄较大、鳞状细胞组织学类型和社会经济地位较低与接受放化疗的几率增加相关。在多变量分析中，放化疗与较差的疾病特异性生存率（风险比[HR]，2.08；95%置信区间[CI]，- 1.64 - 2.64）和总生存率（HR，1.92；95%CI，1.58 - 2.34）相关。接受放化疗与腺癌患者较差的生存率相关（HR，3.01；95%CI，2.24 - 4.04），但鳞状细胞癌患者无显著差异（HR，1.33；95%CI，0.98 - 1.80）。
与放化疗相比，食管切除术可能与老年早期食管癌患者生存率的提高相关。目前的结果表明，可能也有一部分鳞状细胞癌患者，放化疗是足够的治疗方法。一项随机试验将有助于确定老年早期食管癌患者的最佳治疗方法。《癌症》2009年。(c) 2009美国癌症协会。
