Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan.
Department of Advanced Medicine, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan.
Jpn J Clin Oncol. 2021 May 28;51(6):895-904. doi: 10.1093/jjco/hyab030.
The effectiveness of endoscopic treatment for superficial esophageal squamous cell carcinoma in the elderly is unclear.
We retrospectively studied efficacy and safety of endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in 358 patients at our hospital from July 2005 to December 2018. Patients were divided into elderly (≥75 years) and young (≤74 years) groups. Efficacy was evaluated based on overall survival and disease-specific survival, whereas safety was investigated based on the frequency of endoscopic submucosal dissection-related adverse events.
The median observation period was 50 months. The elderly group comprised 111 patients, and young group comprised 247 patients. In the elderly and young groups, 76 (68.5%) and 159 (64.4%) underwent curative resection (P = 0.450), 8 (7.2%) and 34 (13.8%) underwent non-curative resection plus additional treatment and 12 (10.8%) and 15 (6.0%) underwent follow-up, respectively. The frequency of additional treatment for non-curative resection was significantly lower in the elderly group (P = 0.023). The 3-year overall survival of the elderly and young groups was 85.6 and 94.1%, respectively (P = 0.003). The 3-year disease-specific survival of the elderly and young groups was 98.4 and 98.5% (P = 0.682), respectively. The frequency of endoscopic submucosal dissection-related adverse events did not differ significantly between the groups (P = 0.581). The Charlson Comorbidity Index ≥2 was an independent prognostic factor for survival in the elderly group (P = 0.010; hazard ratio, 5.570; 95% confidence interval, 1.519-20.421).
Endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in elderly patients is as safe as that for young patients. The evaluation of Charlson Comorbidity Index was considered to help estimate the prognosis of elderly patients.
内镜治疗老年人表浅性食管鳞状细胞癌的效果尚不清楚。
我们回顾性研究了我院 2005 年 7 月至 2018 年 12 月间 358 例接受内镜黏膜下剥离术治疗的表浅性食管鳞状细胞癌患者的疗效和安全性。患者分为老年（≥75 岁）和年轻（≤74 岁）组。根据总生存率和疾病特异性生存率评估疗效，根据内镜黏膜下剥离术相关不良事件的发生率评估安全性。
中位观察期为 50 个月。老年组 111 例，年轻组 247 例。老年组和年轻组中，分别有 76 例（68.5%）和 159 例（64.4%）行根治性切除（P=0.450），8 例（7.2%）和 34 例（13.8%）行非根治性切除加辅助治疗，12 例（10.8%）和 15 例（6.0%）行随访。老年组非根治性切除后辅助治疗的频率明显较低（P=0.023）。老年组和年轻组的 3 年总生存率分别为 85.6%和 94.1%（P=0.003）。老年组和年轻组的 3 年疾病特异性生存率分别为 98.4%和 98.5%（P=0.682），差异无统计学意义。两组内镜黏膜下剥离术相关不良事件的发生率无显著差异（P=0.581）。老年组Charlson 合并症指数≥2 是生存的独立预后因素（P=0.010；风险比，5.570；95%置信区间，1.519-20.421）。
内镜黏膜下剥离术治疗老年表浅性食管鳞状细胞癌与年轻患者一样安全。评估 Charlson 合并症指数有助于估计老年患者的预后。
