Zeng Yuan, Liang Wenhua, Liu Jun, He Jiaxi, Ng Calvin S H, Liu Chia-Chuan, Petersen René Horsleben, Rocco Gaetano, D'Amico Thomas, Brunelli Alessandro, Chen Haiquan, Zhi Xiuyi, Dong Xiao, Wang Wei, Cui Fei, Xiao Dakai, Wang Wenjun, Yang Wei, Pan Hui, He Jianxing
Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China.
J Thorac Dis. 2018 Jan;10(1):448-457. doi: 10.21037/jtd.2018.01.89.
As the aging issue and increased elderly esophageal cancer (EC) patients, we sought to study the clinical characteristics, treatment modality and outcomes of EC patients 70 years or older compared with those younger than 70 years old.
The national surveillance, epidemiology, and end results (SEER) database for the period from 1973 to 2013 was analyzed. The patient and treatment characteristics were compared between the age groups. Multivariate Cox proportional hazard regression analyses were also performed to identify independent prognostic factors. Propensity-score matching analyses (PSA) regarding survival after different treatments were also performed in locoregional EC.
Compared with the younger group, patients 70 years or older were characterized by having a higher proportion of patients with female gender, white race, localized disease, non-adenocarcinoma and without any treatment, as well as inferior overall survival (OS) [hazard ratio (HR), 1.324] and EC-specific survival (HR, 1.270). In addition, older patients shared same independent prognostic factors with younger patients, including age, histology and race. Specifically, compared with those receiving no intensive treatments, surgery alone (HR, 0.342), both surgery and RT (HR, 0.323) and RT only (HR, 0.525) were favorable among elderly patients, as confirmed by both multivariate adjustment and PSA.
Compared to younger EC patients, those 70 years or older showed distinctive clinical characteristics and inferior survival. Despite showing a higher proportion of localized disease, patients 70 years or older were less likely to be subjected to surgery or/and RT. Thus, the role of intensive treatments, which were identified as favorable factors among elderly patients in this study, warrants further investigation.
随着老龄化问题以及老年食管癌（EC）患者数量的增加，我们试图研究70岁及以上EC患者与70岁以下患者的临床特征、治疗方式及预后。
分析了1973年至2013年期间的国家监测、流行病学和最终结果（SEER）数据库。比较了不同年龄组的患者和治疗特征。还进行了多变量Cox比例风险回归分析以确定独立的预后因素。对局部区域性EC患者也进行了不同治疗后生存的倾向评分匹配分析（PSA）。
与较年轻组相比，70岁及以上患者的特征包括女性、白种人、局限性疾病、非腺癌且未接受任何治疗的患者比例较高，以及总生存期（OS）较差[风险比（HR），1.324]和EC特异性生存期较差（HR，1.270）。此外，老年患者与年轻患者具有相同的独立预后因素，包括年龄、组织学和种族。具体而言，多变量调整和PSA均证实，与未接受强化治疗的患者相比，仅手术（HR，0.342）、手术联合放疗（HR，0.323）和仅放疗（HR，0.525）在老年患者中预后较好。
与年轻的EC患者相比，70岁及以上患者表现出独特的临床特征且生存期较差。尽管70岁及以上患者局限性疾病的比例较高，但他们接受手术或/和放疗的可能性较小。因此，本研究中被确定为老年患者有利因素的强化治疗的作用值得进一步研究。
