荷兰老年潜在可治愈性食管癌患者的确定性放化疗或手术：基于人群的全国性研究，涉及治疗模式和生存情况。
Definitive chemoradiation or surgery in elderly patients with potentially curable esophageal cancer in the Netherlands: a nationwide population-based study on patterns of care and survival.
机构信息
a Department of Surgery , Catharina Hospital Eindhoven , Eindhoven , The Netherlands.
b Department of Research , Netherlands Comprehensive Cancer Organisation (IKNL) , Eindhoven , The Netherlands.
出版信息
Acta Oncol. 2018 Sep;57(9):1192-1200. doi: 10.1080/0284186X.2018.1450521. Epub 2018 Mar 12.
BACKGROUND
The aim of our study was to describe treatment patterns and the impact on overall survival among elderly patients (75 years and older) with potentially curable esophageal cancer.
MATERIAL AND METHODS
Between 2003 and 2013, 13,244 patients from the nationwide population-based Netherlands Cancer Registry (NCR) were diagnosed with potentially curable esophageal cancer (cT2-3, X, any cN, cM0, X) of which 34% were elderly patients (n = 4501).
RESULTS
Surgical treatment with or without neoadjuvant treatment remained stable among elderly patients (around the 16% between 2003 and 2013). However, among younger patients, surgical treatment increased from 60.2 to 67.0%. The use of definitive chemoradiation (dCRT) increased in elderly patients from 1.9 to 19.5% and in younger patients from 5.2 to 17.2%. Due to the increase in dCRT, treatment with curative intent doubled in the elderly from 17 to 37.1%. Multivariable Cox regression revealed that elderly patients with an adenocarcinoma receiving surgery alone or dCRT had a significantly worse overall survival compared to those receiving surgery with neoadjuvant chemo (radio) therapy (nCRT/CT) (HR: 1.7 95% CI 1.4-2.0 and HR: 1.9 95% CI 1.5-2.3). However, among elderly with squamous cell carcinoma overall survival was comparable between dCRT, surgery alone and surgery with nCRT/CT.
CONCLUSIONS
Survival was comparable among elderly patients with squamous cell carcinoma who underwent surgery with nCRT/CT, surgery alone or received dCRT, while elderly patients with an adenocarcinoma who underwent surgery with nCRT/CT had a better overall survival when compared with surgery alone or dCRT. Therefore, dCRT can be considered as a reasonable alternative for surgery among potentially curable elderly patients with esophageal squamous cell carcinoma. However, in elderly patients with esophageal adenocarcinoma surgery with nCRT/CT is still preferable regarding overall survival.
背景
我们的研究旨在描述可治愈的老年食管癌患者（75 岁及以上）的治疗模式以及对总生存的影响。
材料与方法
在 2003 年至 2013 年期间，全国性人群基于荷兰癌症登记处（NCR）的 13244 例可治愈食管癌（cT2-3、X、任何 cN、cM0、X）患者中，有 34%为老年患者（n=4501）。
结果
老年患者中手术治疗（包括新辅助治疗和不包括新辅助治疗）保持稳定（2003 年至 2013 年期间约为 16%）。然而，在年轻患者中，手术治疗的比例从 60.2%增加到 67.0%。老年患者中确定性放化疗（dCRT）的使用率从 1.9%增加到 19.5%，年轻患者从 5.2%增加到 17.2%。由于 dCRT 的增加，老年患者中有治愈意向的治疗方案（包括手术和新辅助化疗（放疗））翻了一番，从 17%增加到 37.1%。多变量 Cox 回归显示，接受单纯手术或 dCRT 的腺癌老年患者的总生存明显差于接受新辅助化疗（放疗）联合手术的患者（HR：1.7，95%CI 1.4-2.0 和 HR：1.9，95%CI 1.5-2.3）。然而，在老年鳞癌患者中，dCRT、单纯手术和新辅助化疗（放疗）联合手术的总生存相似。
结论
对于接受新辅助化疗（放疗）联合手术、单纯手术或 dCRT 的老年食管鳞癌患者，生存情况相似，而对于接受新辅助化疗（放疗）联合手术的腺癌老年患者，总生存情况优于单纯手术或 dCRT。因此，对于可治愈的老年食管鳞癌患者，dCRT 可作为手术的合理替代方案。然而，对于老年食管腺癌患者，新辅助化疗（放疗）联合手术仍然是首选，因为它可以提高总生存率。
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