Vlacich Gregory, Samson Pamela P, Perkins Stephanie M, Roach Michael C, Parikh Parag J, Bradley Jeffrey D, Lockhart A Craig, Puri Varun, Meyers Bryan F, Kozower Benjamin, Robinson Cliff G
Department of Radiation Oncology, Washington University, St. Louis, Missouri.
Department of Medicine, Division of Oncology, Washington University, St. Louis, Missouri.
Cancer Med. 2017 Dec;6(12):2886-2896. doi: 10.1002/cam4.1250. Epub 2017 Nov 15.
For elderly patients with locally advanced esophageal cancer, therapeutic approaches and outcomes in a modern cohort are not well characterized. Patients ≥70 years old with clinical stage II and III esophageal cancer diagnosed between 1998 and 2012 were identified from the National Cancer Database and stratified based on treatment type. Variables associated with treatment utilization were evaluated using logistic regression and survival evaluated using Cox proportional hazards analysis. Propensity matching (1:1) was performed to help account for selection bias. A total of 21,593 patients were identified. Median and maximum ages were 77 and 90, respectively. Treatment included palliative therapy (24.3%), chemoradiation (37.1%), trimodality therapy (10.0%), esophagectomy alone (5.6%), or no therapy (12.9%). Age ≥80 (OR 0.73), female gender (OR 0.81), Charlson-Deyo comorbidity score ≥2 (OR 0.82), and high-volume centers (OR 0.83) were associated with a decreased likelihood of palliative therapy versus no treatment. Age ≥80 (OR 0.79) and Clinical Stage III (OR 0.33) were associated with a decreased likelihood, while adenocarcinoma histology (OR 1.33) and nonacademic cancer centers (OR 3.9), an increased likelihood of esophagectomy alone compared to definitive chemoradiation. Age ≥80 (OR 0.15), female gender (OR 0.80), and non-Caucasian race (OR 0.63) were associated with a decreased likelihood, while adenocarcinoma histology (OR 2.10) and high-volume centers (OR 2.34), an increased likelihood of trimodality therapy compared to definitive chemoradiation. Each treatment type demonstrated improved survival compared to no therapy: palliative treatment (HR 0.49) to trimodality therapy (HR 0.25) with significance between all groups. Any therapy, including palliative care, was associated with improved survival; however, subsets of elderly patients with locally advanced esophageal cancer are less likely to receive aggressive therapy. Care should be taken to not unnecessarily deprive these individuals of treatment that may improve survival.
对于老年局部晚期食管癌患者，现代队列中的治疗方法和结果尚未得到充分描述。从国家癌症数据库中识别出1998年至2012年间诊断为临床II期和III期食管癌的70岁及以上患者，并根据治疗类型进行分层。使用逻辑回归评估与治疗利用相关的变量，并使用Cox比例风险分析评估生存率。进行倾向匹配（1:1）以帮助解释选择偏倚。共识别出21593例患者。中位年龄和最大年龄分别为77岁和90岁。治疗包括姑息治疗（24.3%）、放化疗（37.1%）、三联疗法（10.0%）、单纯食管切除术（5.6%）或不治疗（12.9%）。年龄≥80岁（OR 0.73）、女性（OR 0.81）、Charlson-Deyo合并症评分≥2（OR 0.82）和大容量中心（OR 0.83）与接受姑息治疗而非不治疗的可能性降低相关。年龄≥80岁（OR 0.79）和临床III期（OR 0.33）与可能性降低相关，而腺癌组织学（OR 1.33）和非学术性癌症中心（OR 3.9）与单纯食管切除术相比确定性放化疗的可能性增加相关。年龄≥80岁（OR 0.15）、女性（OR 0.80）和非白种人（OR 0.63）与可能性降低相关，而腺癌组织学（OR 2.10）和大容量中心（OR 2.34）与三联疗法相比确定性放化疗的可能性增加相关。与不治疗相比，每种治疗类型均显示生存率有所提高：从姑息治疗（HR 0.49）到三联疗法（HR 0.25），所有组之间均有显著性差异。任何治疗，包括姑息治疗，均与生存率提高相关；然而，局部晚期食管癌老年患者亚组接受积极治疗的可能性较小。应注意避免不必要地剥夺这些个体可能改善生存的治疗。
