Division of Esophageal Surgery, Akita University Hospital, Akita, Japan.
Department of Comprehensive Cancer Control, Akita University Graduate School of Medicine, Akita, Japan.
Cancer Sci. 2021 Oct;112(10):4281-4291. doi: 10.1111/cas.15070. Epub 2021 Jul 31.
To address the major issue of regional disparity in the treatment for elderly cancer patients in an aging society, we compared the treatment strategies used for elderly patients with thoracic esophageal cancer and their survival outcomes in metropolitan areas and other regions. Using the national database of hospital-based cancer registries in 2008-2011, patients aged 75 years or older who had been diagnosed with thoracic esophageal cancer were enrolled. We divided the patients into two groups: those treated in metropolitan areas (Tokyo, Kanagawa, Osaka, Aichi, Saitama, and Chiba prefectures) with populations of 6 million or more and those treated in other areas (the other 41 prefectures). Compared were patient backgrounds, treatment strategies, and survival curves at each cancer stage. In total, 1236 (24%) patients from metropolitan areas and 3830 (76%) patients from nonmetropolitan areas were enrolled. Patients in metropolitan areas were treated at more advanced stages. There was also a difference in treatment strategy. The 3-year survival rate among cStage I patients was better in metropolitan areas (71.6% vs. 63.7%), and this finding mainly reflected the survival difference between patients treated with radiotherapy alone. For cStage II-IV patients, there were no differences. Multivariable Cox proportional hazard analysis including interaction terms between treatment areas, cStage, and the first-line treatments revealed that treatments in the metropolitan areas were significantly associated with better survival among patients treated with radiotherapy alone for cStage I cancer. Treatment strategies for elderly patients with thoracic esophageal cancer and its survival outcomes differed between metropolitan areas and other regions.
为了解决老龄化社会中老年癌症患者治疗地区差异这一主要问题，我们比较了在大都市地区和其他地区治疗老年胸段食管癌患者的策略及其生存结果。使用 2008-2011 年基于医院的癌症登记全国数据库，纳入年龄≥75 岁且诊断为胸段食管癌的患者。我们将患者分为两组：在人口≥600 万的大都市地区（东京、神奈川、大阪、爱知、埼玉和千叶县）治疗的患者和在其他地区（其余 41 个县）治疗的患者。比较了患者背景、治疗策略和每个癌症阶段的生存曲线。共纳入大都市地区的 1236 名（24%）患者和非大都市地区的 3830 名（76%）患者。大都市地区的患者处于更晚期。治疗策略也存在差异。Ⅰc 期患者的 3 年生存率在大都市地区较好（71.6% vs. 63.7%），这一发现主要反映了单独接受放疗患者的生存差异。对于Ⅱc-IV 期患者，无差异。多变量 Cox 比例风险分析包括治疗区域、cStage 和一线治疗之间的交互项显示，对于单独接受放疗的Ⅰc 期癌症患者，大都市地区的治疗与更好的生存显著相关。大都市地区和其他地区治疗老年胸段食管癌患者的策略及其生存结果存在差异。
