Department of Surgery, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
World J Surg. 2012 Dec;36(12):2872-8. doi: 10.1007/s00268-012-1762-2.
The incidence of esophageal cancer has grown over the recent decades and 30% of esophageal cancer patients are now 75 years or older at the time of diagnosis. The aim of this study was to evaluate trends in management and survival of patients aged 75 years or older with esophageal cancer.
In the Netherlands cancer registry, we identified all patients aged 75 years or older who were diagnosed with esophageal cancer between 1989 and 2008. Trends in management and survival were analyzed by time period (1989-2001 vs. 2002-2008), TNM stage, and age (75-79, 80-84, and 85+ years). χ2 testing was used to analyze time trends in treatment, Kaplan-Meier analysis and log-rank testing to estimate survival, and Cox regression model to calculate hazard ratios for death.
Some 7,253 patients were included in the study. The surgical resection rate increased over the 1989-2008 period from 8.9 to 12.6% (p=0.028), especially among patients aged 75-79 years (44.6 vs. 55.4%, p<0.001) and patients with TNM stage I disease (12.7 vs. 22.0%, p<0.001). The use of definitive chemoradiotherapy (CRT) also increased (0.19 vs. 2.20%, p<0.001). Whereas the use of chemotherapy as a single-modality treatment more than doubled (0.64 vs. 1.54%, p=0.004), that of radiotherapy alone decreased (38.1 vs. 31.6%, p<0.001). Although median survival time was marginally higher in the 2002-2008 period than in 1989-2001, overall 5 year survival rates remained low at 6 and 5%, respectively (p<0.001). Five-year survival rate after surgery increased from 16 to 30% (p<0.001).
In patients of 75 years or older, surgical treatment and use of definitive CRT have increased between 1989 and 2008. Also, an increase in the use of chemotherapy as a single modality was noted. Overall 5 year survival for all cancer patients was stable but remained poor, while survival of patients who underwent esophagectomy improved significantly in the Netherlands since 1989.
在最近几十年，食管癌的发病率有所增加，目前诊断时年龄在 75 岁或以上的食管癌患者占 30%。本研究旨在评估年龄在 75 岁或以上的食管癌患者的治疗和生存趋势。
我们在荷兰癌症登记处中确定了 1989 年至 2008 年间诊断为食管癌的所有 75 岁或以上的患者。通过时间段（1989-2001 年与 2002-2008 年）、TNM 分期和年龄（75-79 岁、80-84 岁和 85 岁以上）分析管理和生存趋势。χ2 检验用于分析治疗的时间趋势，Kaplan-Meier 分析和对数秩检验用于估计生存，Cox 回归模型用于计算死亡的风险比。
该研究共纳入 7253 例患者。1989 年至 2008 年间，手术切除率从 8.9%增加到 12.6%（p=0.028），尤其是在 75-79 岁的患者（44.6%比 55.4%，p<0.001）和 TNM 分期 I 期患者（12.7%比 22.0%，p<0.001）中。根治性放化疗（CRT）的应用也有所增加（0.19%比 2.20%，p<0.001）。作为单一治疗方式的化疗应用增加了一倍多（0.64%比 1.54%，p=0.004），而单纯放疗则减少（38.1%比 31.6%，p<0.001）。尽管 2002-2008 年期间的中位生存时间略高于 1989-2001 年，但总的 5 年生存率仍分别为 6%和 5%（p<0.001）。手术治疗后的 5 年生存率从 16%增加到 30%（p<0.001）。
在 75 岁或以上的患者中，1989 年至 2008 年间，手术治疗和根治性 CRT 的应用有所增加。此外，还注意到化疗作为单一治疗方法的应用有所增加。所有癌症患者的 5 年总生存率保持稳定但仍然较差，而荷兰自 1989 年以来，接受食管癌切除术的患者的生存率显著提高。
