Koterazawa Yasufumi, Goto Hironobu, Aoki Tomoaki, Sawada Ryuichiro, Ikeda Taro, Harada Hitoshi, Otowa Yasunori, Urakawa Naoki, Hasegawa Hiroshi, Kanaji Shingo, Yamashita Kimihiro, Matsuda Takeru, Oshikiri Taro, Miyawaki Daisuke, Sasaki Ryohei, Kakeji Yoshihiro
Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan.
Division of Analytical Biomedical Sciences, Department of Biophysics, Kobe University Graduate School of Health Sciences, 7-10-2, Tomogaoka, Suma-Ku, Kobe City, 654-0142, Japan.
Esophagus. 2025 Jun 25. doi: 10.1007/s10388-025-01139-2.
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.
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.
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).
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.
食管切除术和放化疗（CRT）是食管鳞状细胞癌（ESCC）的主要治疗方法。老年患者常因生理限制无法接受完整的标准治疗。本研究旨在评估可切除的老年ESCC患者手术或非手术治疗的长期预后。
这项回顾性研究纳入了在神户大学医院接受食管切除术的114例患者（手术组）和接受CRT/放疗（RT）的65例患者（非手术组）。进行倾向评分匹配以确定每个肿瘤分期的匹配患者，包括cT1N0 ESCC患者以及cT1N阳性或cT2/3N任何情况的ESCC患者。对于cT1N0 ESCC，每组（手术组和非手术组）各有14例患者。对于cT1N阳性或cT2/3N任何情况的ESCC，每组各有34例患者。
倾向评分匹配后，对于cT1N0患者，手术组的总生存期（OS）显著优于非手术组（p = 0.016）。对于cT1N阳性或cT2/3N任何情况的患者，两组之间的OS无显著差异（p = 0.85）。匹配前，在cT1N0 ESCC患者中，单纯接受RT的患者OS比接受手术或CRT的患者差（p = 0.0003）。在cT1N阳性或cT2/3N任何情况的ESCC患者中，单纯接受RT或单纯接受手术的患者OS比接受新辅助化疗加手术或CRT的患者差（p = 0.023）。
无法接受化疗的患者生存较差。应考虑合适的治疗策略，同时考虑患者一般状况尤其是接受化疗的能力。
