Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Eur J Cardiothorac Surg. 2024 Oct 1;66(4). doi: 10.1093/ejcts/ezae329.
Elderly-specific data for multimodal treatment of oesophageal cancer (EC) is lacking. This study aimed to evaluate the safety and efficacy of multimodal treatment in older EC patients and to compare the impact of neoadjuvant chemotherapy (NCT) and neoadjuvant chemoradiotherapy (NCRT).
Patients diagnosed with oesophageal squamous cell carcinoma or adenocarcinoma who received NCT/NCRT were identified in the National Cancer Database (NCDB, 2004-2015). First, we compared baseline and post-treatment characteristics between younger (<70 years) and older patients (≥70 years). Logistic regression was used to investigate risk factors of postoperative mortality. Second, we evaluated the effect of neoadjuvant chemotherapy on postoperative mortality and overall survival in the older cohort. Inverse probability of treatment weights and multivariable analyses were used to compensate for differences in baseline covariates.
We 1st compared outcomes of neoadjuvant therapy plus oesophagectomy in 14 778 eligible EC patients. The older group experienced higher rates of postoperative mortality at 30 days (5.8%) and 90 days (13.5%) compared to younger patients. Postoperative mortality was significantly related to the Charlson-Deyo score and treatment-related factors including neoadjuvant therapy type and minimally invasive technique. Second, among the 3141 older patients (with a median follow-up of 57.8 months and 2029 deaths), those receiving NCT obtained significantly lower postoperative mortality and improved overall survival compared with NCRT (inverse probability of treatment weights-adjusted P = 0.05; hazard ratio 0.85; 95% Cl 0.72-0.99).
Neoadjuvant therapy plus oesophagectomy carries increased short-term mortality risk in older EC patients. NCT in older EC patients showed lower postoperative mortality but no statistically significant differences in overall survival, with a point estimate favouring NCT compared to the NCRT group, making NCT a potential option for consideration in specific cases.
针对食管癌（EC）的多模式治疗，缺乏老年人特有的数据。本研究旨在评估多模式治疗老年 EC 患者的安全性和有效性，并比较新辅助化疗（NCT）和新辅助放化疗（NCRT）的影响。
在国家癌症数据库（NCDB，2004-2015 年）中，确定接受 NCT/NCRT 治疗的食管鳞状细胞癌或腺癌患者。首先，我们比较了年轻（<70 岁）和老年（≥70 岁）患者的基线和治疗后特征。使用逻辑回归分析术后死亡率的危险因素。其次，我们评估了新辅助化疗对老年患者术后死亡率和总生存的影响。使用逆概率处理权重和多变量分析来补偿基线协变量的差异。
我们首先比较了 14778 例符合条件的 EC 患者接受新辅助治疗加食管癌切除术的结果。与年轻患者相比，老年组在术后 30 天（5.8%）和 90 天（13.5%）的术后死亡率更高。术后死亡率与 Charlson-Deyo 评分和治疗相关因素显著相关，包括新辅助治疗类型和微创技术。其次，在 3141 例老年患者（中位随访 57.8 个月，2029 例死亡）中，与 NCRT 相比，接受 NCT 的患者术后死亡率显著降低，总生存率提高（逆概率处理权重调整的 P=0.05；风险比 0.85；95%Cl 0.72-0.99）。
新辅助治疗加食管癌切除术在老年 EC 患者中具有较高的短期死亡率风险。老年 EC 患者的 NCT 术后死亡率较低，但总生存率无统计学差异，与 NCRT 组相比，NCT 组的估计值略有优势，使 NCT 成为特定情况下的潜在选择。
