Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto ON, Canada.
Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Oncologist. 2024 Nov 4;29(11):e1501-e1510. doi: 10.1093/oncolo/oyae190.
The incidence of esophageal and gastric carcinoma (GEC) in elderly patients is increasing, yet patients ≥75 years have historically been underrepresented in clinical trials. We sought to investigate palliative chemotherapy administration patterns and survival outcomes in older adults.
A retrospective analysis identified patients aged 65-74 (young-old) and ≥75 years (older-old) diagnosed with advanced GEC. Patient and tumor characteristics were recorded, with descriptive analysis, time-to-event data analysis using Kaplan-Meier curves and multivariate Cox proportional hazards regression analysis performed.
One hundred and ninety-eight "young-old" and 109 'older-old' patients were identified. Patient characteristics were similar between groups except for Charlson Co-morbidity Index (CCI), with lower co-morbidities in the "young-old" compared to "older-old" cohort (P < .001; CCI = 0 in 103 (52%) "young-old" vs 31 (28%) "older-old"). The primary diagnosis in both groups was adenocarcinoma. 119 (60%) "young-old" and 25 (23%) "older-old" patients received chemotherapy (P < .001). Performance status was the primary explanation for chemotherapy non-receipt in both cohorts; age was the explanation in 21 (25%) "older-old" patients and none in the "young-old" patients. PFS for first-line systemic therapy in "young-old" patients was 6.4 (95% CI 5.9-7.6) versus 7.5 months (95% CI 5.1-11.3) in "older-old" patients (P = .69) whilst respective OS was 12.3 (95% CI 10.1-15.5) and 10.4 months (95% CI 9.0-14.6) (P = .0816). Toxicity prompted chemotherapy cessation in 17 (15%) "young-old" and 3 (13%) "older-old" patients (P = .97). Multivariate analysis identified CCI and ECOG performance status as predictive for PFS and OS, respectively. No causative relationship was identified with other variables.
Our study of real-world older-adults show that significant number of "older-old" patients with GEC do not receive chemotherapy. Among "older-old" adults who do receive systemic therapy, outcomes are comparable; this underscores the importance of geriatric assessment-guided care and suggests that age alone should not be a barrier to receipt of chemotherapy in patients with advanced GEC.
老年患者食管癌和胃癌（GEC）的发病率正在上升，但历史上 75 岁以上的患者在临床试验中代表性不足。我们旨在研究老年患者姑息性化疗的管理模式和生存结局。
回顾性分析确定了年龄在 65-74 岁（年轻老年）和≥75 岁（老年老年）的晚期 GEC 患者。记录患者和肿瘤特征，使用 Kaplan-Meier 曲线进行描述性分析、生存时间数据分析和多变量 Cox 比例风险回归分析。
确定了 198 名“年轻老年”和 109 名“老年老年”患者。两组患者的特征除 Charlson 合并症指数（CCI）外相似，年轻老年组的合并症较少（P<0.001；CCI=0 的患者分别为 103 例（52%）“年轻老年”和 31 例（28%）“老年老年”）。两组的主要诊断均为腺癌。119 名（60%）“年轻老年”和 25 名（23%）“老年老年”患者接受了化疗（P<0.001）。在两个队列中，体能状态都是未接受化疗的主要原因；在 21 名（25%）“老年老年”患者中，年龄是原因，而在“年轻老年”患者中没有。“年轻老年”患者一线系统治疗的 PFS 为 6.4 个月（95%CI 5.9-7.6），而“老年老年”患者为 7.5 个月（95%CI 5.1-11.3）（P=0.69），相应的 OS 分别为 12.3 个月（95%CI 10.1-15.5）和 10.4 个月（95%CI 9.0-14.6）（P=0.0816）。毒性导致 17 名（15%）“年轻老年”和 3 名（13%）“老年老年”患者停止化疗（P=0.97）。多变量分析确定 CCI 和 ECOG 体能状态分别为 PFS 和 OS 的预测因素。其他变量与两者之间没有因果关系。
我们对真实世界老年患者的研究表明，大量 GEC“老年老年”患者未接受化疗。在接受系统治疗的“老年老年”成人中，结果相当；这强调了老年评估指导护理的重要性，并表明年龄本身不应成为晚期 GEC 患者接受化疗的障碍。
