老年晚期浅表性食管鳞状细胞癌内镜切除的长期预后

Long-term outcomes of endoscopic resection of superficial esophageal squamous cell carcinoma in late-elderly patients.

作者信息

Matsueda Katsunori, Kawano Seiji, Fukui Keisuke, Hirata Shoichiro, Satomi Takuya, Inoo Shoko, Hamada Kenta, Kono Yoshiyasu, Iwamuro Masaya, Kawahara Yoshiro, Otsuka Motoyuki

机构信息

Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan.

Faculty of Societal Safety Sciences, Kansai University, Osaka, Japan.

出版信息

J Gastroenterol Hepatol. 2024 Dec;39(12):2664-2671. doi: 10.1111/jgh.16764. Epub 2024 Oct 14.

DOI:10.1111/jgh.16764

PMID:39402867

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11660204/

Abstract

BACKGROUND AND AIM

As the population ages, the number of elderly patients with superficial esophageal squamous cell carcinoma (ESCC) is increasing. We aimed to clarify the indications for endoscopic resection (ER) in late-elderly patients with ESCC in terms of life expectancy.

METHODS

Patients aged ≥75 years who underwent ER for ESCC at our institution from January 2005 to December 2018 were enrolled. Clinical data, including the Eastern Cooperative Oncology Group performance status, American Society of Anesthesiologists physical status (ASA-PS), Charlson comorbidity index, and prognostic nutritional index (PNI), were collected at the time of ER. The main outcome measure was overall survival (OS).

RESULTS

Two hundred eight consecutive patients were enrolled. The patients' median age was 78 years (range, 75-89 years). The 5-year follow-up rate was 88.5% (median follow-up period, 6.6 years). The 5-year OS rate was 79.2% (95% confidence interval [CI], 72.2-84.8), and 5-year net survival standardized for age, sex, and calendar year was 1.04 (95% CI, 0.98-1.09). In the multivariate analysis, an ASA-PS of 3 (hazard ratio, 2.45; 95% CI, 1.16-5.17) and PNI of <44.0 (hazard ratio, 2.73; 95% CI, 1.38-5.40) were independent prognostic factors. When neither of these factors was met, the 5-year OS rate was 87.8% (95% CI, 80.0-92.9), and 5-year net survival was 1.08 (95% CI, 1.02-1.14).

CONCLUSIONS

ER for ESCC in late-elderly patients may improve life expectancy. ER is recommended in patients with a good ASA-PS and PNI.

摘要

背景与目的

随着人口老龄化，老年浅表性食管鳞状细胞癌（ESCC）患者数量不断增加。我们旨在从预期寿命的角度阐明老年晚期ESCC患者内镜下切除术（ER）的适应证。

方法

纳入2005年1月至2018年12月在本机构接受ESCC的ER治疗的年龄≥75岁的患者。在ER时收集临床数据，包括东部肿瘤协作组体能状态、美国麻醉医师协会身体状况（ASA-PS）、查尔森合并症指数和预后营养指数（PNI）。主要结局指标为总生存期（OS）。

结果

连续纳入208例患者。患者的中位年龄为78岁（范围75-89岁）。5年随访率为88.5%（中位随访期6.6年）。5年OS率为79.2%（95%置信区间[CI]，72.2-84.8），按年龄、性别和日历年标准化的5年净生存率为1.04（95%CI，0.98-1.09）。多因素分析中，ASA-PS为3（风险比，2.45；95%CI，1.16-5.17）和PNI<44.0（风险比，2.73；95%CI，1.38-5.40）是独立的预后因素。当这两个因素均不满足时，5年OS率为87.8%（95%CI，80.0-92.9），5年净生存率为1.08（95%CI，1.02-1.14）。