Iguchi Takuya, Nakamura Satoshi, Kitazawa Masato, Yamamoto Yuta, Miyazaki Satoru, Hondo Nao, Kataoka Masahiro, Tanaka Hirokazu, Aoki Ryosuke, Yonghan Park, Soejima Yuji
Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
In Vivo. 2025 Jul-Aug;39(4):2286-2294. doi: 10.21873/invivo.14024.
BACKGROUND/AIM: Esophageal cancer is a leading cause of death among males worldwide, including Japan, where squamous cell carcinoma is the most common type. Treatment decisions can be complicated, especially for older patients undergoing esophagectomy, which, while effective, is invasive and incurs significant risks.
A retrospective review of 126 consecutive patients with esophageal squamous cell carcinoma (ESCC) who underwent open or thoracoscopic esophagectomy between January 2010 and April 2023 was conducted. Older patients aged ≥75 years (n=24) were compared with non-older patients aged <75 years (n=102).
Both estimated Glomerular Filtration Rate (eGFR) and albumin levels were notably lower in older patients with a more extensive medical history and higher American Society of Anesthesiologists Physical Status scores. However, there were no differences in sex, Body Mass Index, or pathological stage. Both groups showed similar characteristics in terms of the esophagectomy approach, field dissection, preoperative treatment, operation duration, bleeding, postoperative complications, and hospital stay. No differences were observed between non-older and older groups regarding overall survival (OS), recurrence-free survival (RFS), and disease-specific survival (DSS) (5-year OS: 63.4% . 29.2%, respectively, =0.119; 5-year RFS: 48.6% . 33.9%, respectively, =0.612; 5-year DSS: 73.2% and 46.2%, respectively, =0.978). Additionally, multivariate survival analysis indicated that pathological N stage [hazard ratio (HR)=2.13; 95% confidence interval (CI)=1.10-4.12; =0.025] and pathological T stage (HR=2.16; 95%CI=1.13-4.15; =0.021) were independent prognostic factors for OS. However, age was not a prognostic factor.
Esophagectomy for patients aged 75 years or older provides comparable long-term outcomes without increasing postoperative complications compared with patients younger than 75 years.
背景/目的：食管癌是包括日本在内的全球男性主要死因，在日本，鳞状细胞癌是最常见的类型。治疗决策可能很复杂，尤其是对于接受食管切除术的老年患者，尽管该手术有效，但具有侵入性且存在重大风险。
对2010年1月至2023年4月期间连续接受开放或胸腔镜食管切除术的126例食管鳞状细胞癌（ESCC）患者进行回顾性研究。将年龄≥75岁的老年患者（n = 24）与年龄<75岁的非老年患者（n = 102）进行比较。
老年患者的估计肾小球滤过率（eGFR）和白蛋白水平均显著较低，他们有更广泛的病史且美国麻醉医师协会身体状况评分更高。然而，在性别、体重指数或病理分期方面没有差异。两组在食管切除术方式、区域清扫、术前治疗、手术时间、出血量、术后并发症和住院时间方面表现出相似的特征。在总生存期（OS）、无复发生存期（RFS）和疾病特异性生存期（DSS）方面，非老年组和老年组之间未观察到差异（5年OS分别为63.4%和29.2%，P = 0.119；5年RFS分别为48.6%和33.9%，P = 0.612；5年DSS分别为73.2%和46.2%，P = 0.978）。此外，多因素生存分析表明，病理N分期[风险比（HR）= 2.13；95%置信区间（CI）= 1.10 - 4.12；P = 0.025]和病理T分期（HR = 2.16；95%CI = 1.13 - 4.15；P = 0.021）是OS的独立预后因素。然而，年龄不是预后因素。
与75岁以下患者相比，75岁及以上患者接受食管切除术可提供相当的长期预后，且不会增加术后并发症。
