St James University Hospital, St James Institute of Oncology, Leeds, UK.
Clin Oncol (R Coll Radiol). 2010 Mar;22(2):107-13. doi: 10.1016/j.clon.2009.12.001. Epub 2010 Jan 6.
Most patients with advanced gastroesophageal cancer are elderly, but current standard regimens have emerged from trials predominantly involving patients with a median age <65 years. The aim of this study was to assess the factors influencing survival outcome for an elderly gastroesophageal cancer non-trial population.
We reviewed the case notes of all patients in our centre over the age of 65 years who received palliative chemotherapy for gastroesophageal cancer over a period of 3.5 years. Patients were classified as having received standard, non-standard combination or single-agent chemotherapy. After an initial univariate analysis, a multivariate analysis of the most significant prognostic factors was carried out.
In total, 120 patients were suitable for analysis. The median overall survival for patients receiving standard chemotherapy was 8.1 months, non-standard combination 8.3 months and single-agent fluoropyrimidines 3.9 months. Poor prognosis was predicted by two independent factors: poor performance status (hazard ratio 2.402; 95% confidence interval 1.53-3.77, P<0.001) and the presence of cancer symptoms (hazard ratio 2.235; 95% confidence interval 1.32-3.79, P=0.003).
An assessment of the performance status and the level of symptoms is vital in this vulnerable group of patients. Prospective randomised trials to assess the benefit of chemotherapy in elderly patients with gastroesophageal cancer are required.
大多数晚期胃食管癌症患者为老年人，但目前的标准治疗方案主要来自于纳入中位年龄<65 岁患者的临床试验。本研究旨在评估影响老年胃食管癌症非试验人群生存结果的因素。
我们回顾了 3.5 年内在我们中心接受姑息性化疗的年龄超过 65 岁的所有胃食管癌症患者的病历。患者被分为接受标准、非标准联合或单药化疗的患者。在初始单因素分析后，对最重要的预后因素进行了多因素分析。
共 120 例患者适合进行分析。接受标准化疗的患者中位总生存期为 8.1 个月，非标准联合化疗为 8.3 个月，单药氟嘧啶类药物为 3.9 个月。两个独立因素预测预后不良：一般状况较差（风险比 2.402；95%置信区间 1.53-3.77，P<0.001）和癌症症状存在（风险比 2.235；95%置信区间 1.32-3.79，P=0.003）。
在这一脆弱患者群体中，评估一般状况和症状水平至关重要。需要进行前瞻性随机试验，以评估化疗对老年胃食管癌症患者的益处。
