Medizinische Klinik III, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Interdisziplinäres Tumorzentrum Mannheim, Universitätsmedizin Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Drugs Aging. 2019 May;36(5):403-409. doi: 10.1007/s40266-019-00638-z.
Gastroesophageal cancer is the fourth most frequent malignant disease and, despite significant advances in chemotherapy, the prognosis of unresectable or recurrent gastroesophageal cancer is poor. The majority of patients, nearly two-thirds, are over the age of 65 years at diagnosis. Elderly patients are a heterogeneous population and aging occurs at different rates in different individuals. The chronological age of a patient does not necessarily reflect the physiological age. However, elderly patients are more likely to have a number of concomitant diseases and impaired organ function, which should be considered when making treatment decisions. Therefore, treatment in older adults requires particular caution, and physiologic age rather than chronologic age should be considered when deciding for or against systemic therapy. Older patients are generally underrepresented in clinical trials and many elderly patients do not receive effective combination therapies due to concerns with tolerability. Age itself is not a negative predictive factor and treatment should not be omitted just on the basis of chronological age. Older patients who fulfill the standard inclusion criteria of clinical trials seem to have a similar advantage from palliative chemotherapy for gastroesophageal adenocarcinoma as younger patients; however, large prospective trials in the elderly population are needed to guide clinicians in making evidence-based decisions.
胃食管交界癌是第四大常见恶性肿瘤，尽管化疗取得了显著进展，但不可切除或复发性胃食管交界癌的预后仍然较差。大多数患者（近三分之二）在诊断时年龄超过 65 岁。老年患者是一个异质群体，不同个体的衰老速度不同。患者的实际年龄并不一定反映其生理年龄。然而，老年患者往往患有多种并存疾病和器官功能受损，在做出治疗决策时应考虑这些因素。因此，老年患者的治疗需要特别谨慎，在决定是否进行系统治疗时，应考虑生理年龄而不是实际年龄。临床试验中通常较少纳入老年患者，由于对耐受性的担忧，许多老年患者并未接受有效的联合治疗。年龄本身并不是一个负面的预测因素，不应仅仅基于实际年龄而排除治疗。符合临床试验标准纳入标准的老年患者，似乎与年轻患者一样，从姑息性化疗中获益；然而，需要在老年人群中进行大型前瞻性试验，以指导临床医生做出基于证据的决策。
