Department of Surgery, National Defense Medical College, Tokorozawa, Japan.
Nagoya J Med Sci. 2022 May;84(2):388-401. doi: 10.18999/nagjms.84.2.388.
Although the Japan Clinical Oncology Group trial demonstrated that neoadjuvant chemotherapy (NAC) with 5-fluorouracil plus cis-diamminedichloroplatinum had significant survival benefits, it excluded elderly patients aged ≥ 76 years. Therefore, our study aimed to evaluate the tolerability of NAC in elderly patients with esophageal cancer. Classified 174 patients with clinical stage II/III esophageal cancer who underwent esophagectomy from 2010 to 2020 into the E (aged ≥ 76 years; 55 patients) and Y (aged < 76; 119 patients) groups, and retrospectively investigated for clinicopathological findings, tolerability of NAC, relative dose intensity (RDI) and short- and long-term result. Patients who received NAC were fewer in the E group than in the Y group (51% vs 77%, = 0.001). The E group had relatively lower completion rate of NAC (71% vs 85%, = 0.116) and significantly lower mean RDI of 5-fluorouracil and cis-diamminedichloroplatinum than the Y group (73% vs 89%, < 0.001). However, histological and radiological were comparable between both groups. Severe adverse events (grade ≥ 3) were relatively frequent (E, 42.9%; Y, 27.5%, = 0.091), especially, neutropenia was significantly more frequent in the E group (25.0% vs 7.7%, = 0.022). There were no differences in the incidence of postoperative complications between with and without NAC in both E and Y groups. Elderly patients with esophageal cancer might be more susceptible to toxicity of NAC. Hence, adequate case selection and careful of dose reduction are needed for elderly with esophageal cancer.
虽然日本临床肿瘤学组试验表明，5-氟尿嘧啶加顺铂的新辅助化疗（NAC）具有显著的生存获益，但它排除了年龄≥76 岁的老年患者。因此，我们的研究旨在评估 NAC 在老年食管癌患者中的耐受性。将 2010 年至 2020 年间接受食管癌切除术的 174 例临床 II/III 期食管癌患者分为 E（年龄≥76 岁；55 例）和 Y（年龄<76 岁；119 例）组，回顾性调查临床病理特征、NAC 耐受性、相对剂量强度（RDI）以及短期和长期结果。E 组接受 NAC 的患者少于 Y 组（51% vs 77%， = 0.001）。E 组 NAC 完成率相对较低（71% vs 85%， = 0.116），5-氟尿嘧啶和顺铂的平均 RDI 明显低于 Y 组（73% vs 89%，<0.001）。然而，两组的组织学和影像学结果相似。严重不良事件（≥3 级）发生率相对较高（E 组 42.9%；Y 组 27.5%， = 0.091），特别是 E 组中性粒细胞减少症明显更常见（25.0% vs 7.7%， = 0.022）。E 组和 Y 组中，有无 NAC 治疗的术后并发症发生率均无差异。老年食管癌患者可能对 NAC 的毒性更敏感。因此，对于老年食管癌患者，需要进行适当的病例选择和剂量减少。
