Berger Anne Katrin, Zschaebitz Stefanie, Komander Christine, Jäger Dirk, Haag Georg Martin
Anne Katrin Berger, Stefanie Zschaebitz, Dirk Jäger, Georg-Martin Haag, National Center for Tumor Diseases, Heidelberg University Hospital, 69120 Heidelberg, Germany.
World J Gastroenterol. 2015 Apr 28;21(16):4911-8. doi: 10.3748/wjg.v21.i16.4911.
To investigate the outcome of palliative chemotherapy in old patients with gastroesophageal cancer at the National Center for Tumor Diseases, Heidelberg.
Using a prospectively generated database, we retrospectively analyzed 55 patients ≥ 70 years under palliative chemotherapy for advanced gastroesophageal cancer at the outpatient clinic of the National Center for Tumor Diseases Heidelberg, Germany between January 2006 and December 2013. Further requirements for inclusion were (1) histologically proven diagnosis of gastroesophageal cancer; (2) advanced (metastatic or inoperable) disease; and (3) no history of radiation or radiochemotherapy. The clinical information included Eastern Cooperative Oncology Group performance status (ECOG PS), presence and site of metastases at diagnosis, date of previous surgery and perioperative chemotherapy, start and stop date of first-line treatment, toxicities and consecutive dosage reductions of first-line treatment, response to first-line therapy, date of progression, usage of second-line therapies and date and cause of death. Survival times [progression-free survival (PFS), overall survival (OS) and residual survival (RS)] were calculated. Toxicity and safety were examined. Prognostic factors including ECOG PS, age and previous perioperative treatment were analyzed.
Median age of our cohort was 76 years. 86% of patients received a combination of two cytotoxic drugs. 76 percent of patients had an oxaliplatin-based first-line therapy with the oxaliplatin and 5-fluorouracil regimen being the predominantely chosen regimen (69%). Drug modifications due to toxicity were necessary in 56% of patients, and 11% of patients stopped treatment due to toxicities. Survival times of our cohort are in good accordance with the major phase III trials that included mostly younger patients: PFS and OS were 5.8 and 9.5 mo, respectively. Survival differed significantly between patient groups with low (≤ 1) and high (≥ 2) ECOG PS (12.7 mo vs 3.8 mo, P < 0.001). Very old patients (≥ 75 years) did not show a worse outcome in terms of survival. Patients receiving second-line treatment (51%) had a significantly longer RS than patients with best supportive care (6.8 vs 1.4 mo, P = 0.001). Initial ECOG PS was a strong prognostic factor for PFS, OS and RS.
Old patients with non-curable gastroesophageal cancer should be offered chemotherapy, and ECOG PS is a tool for balancing benefit and harm upfront. Second-line treatment is reasonable.
在德国海德堡国家肿瘤疾病中心，研究老年食管癌患者姑息化疗的疗效。
利用前瞻性生成的数据库，我们回顾性分析了2006年1月至2013年12月期间在德国海德堡国家肿瘤疾病中心门诊接受晚期食管癌姑息化疗的55例年龄≥70岁的患者。纳入的其他要求为：（1）经组织学证实的食管癌诊断；（2）晚期（转移性或不可切除）疾病；（3）无放疗或放化疗史。临床信息包括东部肿瘤协作组体能状态（ECOG PS）、诊断时转移灶的存在及部位、既往手术和围手术期化疗日期、一线治疗的开始和结束日期、一线治疗的毒性及连续剂量减少情况、一线治疗的反应、疾病进展日期、二线治疗的使用情况以及死亡日期和原因。计算生存时间[无进展生存期（PFS）、总生存期（OS）和残余生存期（RS）]。检查毒性和安全性。分析包括ECOG PS、年龄和既往围手术期治疗在内的预后因素。
我们队列的中位年龄为76岁。86%的患者接受了两种细胞毒性药物联合治疗。76%的患者接受了以奥沙利铂为基础的一线治疗，奥沙利铂和5-氟尿嘧啶方案是最常选用的方案（69%）。56%的患者因毒性需要调整药物，11%的患者因毒性停止治疗。我们队列的生存时间与主要的Ⅲ期试验结果高度一致，这些试验大多纳入了较年轻的患者：PFS和OS分别为5.8个月和9.5个月。ECOG PS低（≤1）和高（≥2）的患者组生存情况有显著差异（12.7个月对3.8个月，P<0.001）。高龄患者（≥75岁）在生存方面并未表现出更差的结果。接受二线治疗的患者（51%）的RS显著长于接受最佳支持治疗的患者（6.8个月对1.4个月，P = 0.001）。初始ECOG PS是PFS、OS和RS的强预后因素。
不可治愈的老年食管癌患者应接受化疗，ECOG PS是一种在治疗前权衡利弊的工具。二线治疗是合理的。
