Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China.
Cancer Med. 2021 Dec;10(23):8483-8496. doi: 10.1002/cam4.4352. Epub 2021 Nov 19.
The optimal treatment for elderly patients with esophageal cancer (EC) remains controversial. In the present study, we aimed to investigate whether elderly patients with stage II-III EC could benefit from trimodal therapy.
The selected elderly patients with stage II-III EC between 2004 and 2015 were included in a retrospective cohort study from the Surveillance, Epidemiology, and End Results database. The patients were divided into two groups based on whether or not they underwent surgery. The inverse probability of treatment weighting (IPTW) analysis was used to balance the confounding factors between the two groups. The Cox regression analysis, the log-rank test, and the Kaplan-Meier curves were conducted to identify the survival benefits of different treatment regimes.
A total of 1596 patients were included in this cohort study, in which 278 patients underwent surgery. In the combination of chemoradiotherapy and surgery group, there were more male patients, more patients aged between 75 and 79 years, and more married patients in the surgery group. Moreover, there were more patients with adenomatous carcinoma, more patients with a tumor size of less than 5 cm, and more patients with a T3 stage in the combination group. In the survival analysis, patients in the combination group had a longer overall survival (OS) and EC-specific survival (ECSS). After IPTW analysis, the survival analysis generated similar results. The competitive risk model found that our results were stable. There was still a significant difference in OS and ECSS between the combination group and chemoradiotherapy alone group for esophageal adenocarcinoma (p < 0.001).
Elderly patients with stage II-III EC, especially those with adenocarcinoma, could benefit from the combination of surgery and chemoradiotherapy.
老年食管癌（EC）患者的最佳治疗方法仍存在争议。本研究旨在探讨Ⅱ-Ⅲ期老年 EC 患者是否能从三联疗法中获益。
从 Surveillance，Epidemiology，and End Results 数据库中选取 2004 年至 2015 年间的Ⅱ-Ⅲ 期老年 EC 患者进行回顾性队列研究。根据是否接受手术将患者分为两组。采用逆概率治疗加权（IPTW）分析平衡两组间的混杂因素。采用 Cox 回归分析、对数秩检验和 Kaplan-Meier 曲线确定不同治疗方案的生存获益。
本队列研究共纳入 1596 例患者，其中 278 例行手术。在放化疗联合手术组中，手术组的男性患者更多，75-79 岁的患者更多，已婚患者更多。此外，联合组中腺瘤性癌患者更多，肿瘤大小<5cm 的患者更多，T3 期患者更多。生存分析显示，联合组患者的总生存（OS）和 EC 特异性生存（ECSS）更长。经 IPTW 分析后，生存分析结果相似。竞争风险模型发现我们的结果稳定。对于食管腺癌，联合组与单纯放化疗组在 OS 和 ECSS 方面仍存在显著差异（p<0.001）。
Ⅱ-Ⅲ 期老年 EC 患者，尤其是腺癌患者，可从手术联合放化疗中获益。
