A comparison of the clinical outcomes of esophagectomy and chemoradiotherapy for patients aged 75 years or older with surgically resectable esophageal squamous cell carcinoma.

PURPOSE

Esophagectomy and chemoradiotherapy (CRT) are the mainstays of treatment for esophageal squamous cell carcinoma (ESCC). Older patients often do not receive full standard treatment due to physiological limitations. This study aimed to assess the long-term prognosis of surgery or non-surgery treatment for older patients with resectable ESCC.

METHODS

This retrospective study included 114 patients who underwent esophagectomy (surgery group) and 65 patients who underwent CRT/radiotherapy (RT) (non-surgery group) at Kobe University Hospital. Propensity score matching was performed to identify matched patients in each tumor stage, including those with cT1N0 ESCC and cT1N-positive or cT2/3N-any ESCC. For cT1N0 ESCC, each group (surgery and non-surgery) had 14 patients. For cT1N-positive or cT2/3N-any ESCC, each group had 34 patients.

RESULTS

After propensity score matching, for patients with cT1N0, the overall survival (OS) of the surgery group was significantly better than that of the non-surgery groups (p = 0.016). For cT1N-positive or cT2/3N-any patients, no significant differences were observed in OS between the two groups (p = 0.85). Before matching, in patients with cT1N0 ESCC, those who underwent RT alone had worse OS than patients who underwent surgery or CRT (p = 0.0003). In patients with cT1N-positive or cT2/3N-any ESCC, those who underwent RT alone or surgery alone had worse OS than those who underwent neoadjuvant chemotherapy plus surgery or CRT (p = 0.023).

CONCLUSIONS

Patients who could not receive chemotherapy had poor survival. An appropriate treatment strategy should be considered, taking into account their general condition, especially their ability to receive chemotherapy.