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Abstract
BackgroundThe number of patients diagnosed with early stage disease (T1a or T1b) has been increasing. This study was conducted to investigate the effect of esophagectomy (ES), endoscopic therapy (ET), and radiotherapy (RT) on long‐term survival in elderly patients with cT1N0M0 esophageal cancer.MethodsWe searched the Surveillance, Epidemiology, and End Results (SEER) database to identify the records of elderly patients (≥ 75 years) with cT1N0M0 esophageal cancer between 2004 and 2014. Patient demographics and esophageal cancer parameters were compared among ES, ET, and RT groups. The Kaplan–Meier method and Cox proportional hazard modeling were used to compare long‐term survival.ResultsData from 954 esophageal cancer patients (ES: n = 196; ET: n = 224; RT: n = 534) were identified. Multivariate Cox regression analysis showed that five‐year survival in the ET and ES groups was significantly higher than in the RT group. After propensity score matching, we found no difference in five‐year survival between ES and ET.ConclusionUsing SEER data, we identified a significant survival advantage with the use of ES and ET compared to RT in patients with cT1N0M0 esophageal cancer aged > 75 years, while the long‐term survival of patients after ET and ES was not significantly different.
Highlights
Esophageal cancer is a common digestive cancer and the sixth leading cause of cancer death worldwide, with more than 450 000 diagnoses and 400 000 deaths in 2012.1,2 diagnostic techniques and treatment of esophageal cancer has improved over the last few decades, the overall five-year survival rate is still only 15–25%.3,4 Because of an awareness of early lesions by endoscopists, early stage cancer patients are seen more frequently
Recent advances in radiotherapy (RT) have shown promise for improving outcomes and survival, and decreasing recurrence and metastasis[4,10] the outcome of RT remains unsatisfactory in terms of lung and heart toxicity, and survival in elderly cancer patients is impaired by comorbidities and reduced performance status[11] Recently, endoscopic therapy (ET) has become widely accepted for the treatment of early esophageal cancer[12,13] ET might result in inadequate resection or staging because of the absence of lymphadenectomy
There was an increase in the proportion of patients who underwent ET from the year of diagnosis in 2004–2009 (19.1%) to
Summary
Esophageal cancer is a common digestive cancer and the sixth leading cause of cancer death worldwide, with more than 450 000 diagnoses and 400 000 deaths in 2012.1,2 diagnostic techniques and treatment of esophageal cancer has improved over the last few decades, the overall five-year survival rate is still only 15–25%.3,4 Because of an awareness of early lesions by endoscopists, early stage cancer patients are seen more frequently. Recent advances in radiotherapy (RT) have shown promise for improving outcomes and survival, and decreasing recurrence and metastasis[4,10] the outcome of RT remains unsatisfactory in terms of lung and heart toxicity, and survival in elderly cancer patients is impaired by comorbidities and reduced performance status[11] Recently, ET (endoscopic polypectomy or mucosal resection, photodynamic therapy, radiofrequency ablation, and freezing treatment) has become widely accepted for the treatment of early esophageal cancer[12,13] ET might result in inadequate resection or staging because of the absence of lymphadenectomy. Conclusion: Using SEER data, we identified a significant survival advantage with the use of ES and ET compared to RT in patients with cT1N0M0 esophageal cancer aged > 75 years, while the long-term survival of patients after ET and ES was not significantly different
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