Optimal treatment strategy for older patients with esophageal squamous cell carcinoma: A multicenter retrospective study.

The appropriate treatment strategy for esophageal squamous cell carcinoma (ESCC) in older patients remains unclear. The efficacy of preoperative chemotherapy using a divided-dose regimen of biweekly docetaxel, cisplatin and 5-fluorouracil (DCF) neoadjuvant chemotherapy (NAC) was compared with upfront surgery (US) in patients aged ≥70 years with ESCC. The present study retrospectively analyzed the multicenter data of patients who received esophagectomy for ESCC between January 2015 and December 2021. The present study investigated patient prognosis using inverse probability weighting analysis and psoas muscle index (PMI) as a background factor for older patients with ESCC potentially deriving greater benefit from this NAC regimen. Among 86 eligible patients, 47 received NAC (NAC group) and 39 underwent US (US group). No significant differences were observed between the groups in 3-year overall survival [OS; hazard ratio (HR), 0.576; P=0.325) and 3-year recurrence-free survival (HR, 0.483; P=0.141). Among the patients with low PMI, 3-year OS was significantly prolonged in the NAC group vs. the US group (HR, 0.342; 95% CI, 0.144-0.812; P=0.015). In the older patients with ESCC, a divided-dose regimen of DCF did not improve prognosis. When the PMI is low, a biweekly DCF regimen may contribute to extending OS. Future prospective large studies are needed.