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Abstract
BackgroundEsophageal cancer (EC) is a common and lethal carcinoma; however, the effectiveness and feasibility of the chemo- and radio-therapy (CRT) for the elderly patients (≥ 70 years) with surgery have not been fully discussed. The purpose of this study was to investigate the potential effect of CRT on the prognosis.MethodsA total of 1085 patients (534 CRT patients vs. 551 non-CRT patients) from 1998 to 2016 were collected from the Surveillance, Epidemiology, and End Results database according to the inclusion and exclusion criteria. Using the competing risk regression and survival analysis, an overall estimation of the effectiveness of CRT was performed on a well-balanced cohort via performing propensity score matching. Then, the specific impact of CRT on high- (n = 557) and low-risk (n = 528) cohorts derived from the nomogram’s risk quantification for every patient were further evaluated respectively. Additionally, the advantages of the nomogram model and the conventional tumor, node, metastasis (TNM, 6th revision) staging system were compared.ResultsA better survival outcome was observed among patients receiving both surgery and CRT than those who underwent surgery alone (HR: 0.55, 95% CI 0.45–0.68, P < 0.001), especially for those with tumors characterized by poor differentiation, large tumor size, advanced T staging, lymphatic metastasis, and distant metastasis (HR: 0.48, 95% CI 0.39–0.59, P < 0.001), while no benefit was observed among the low-risk patients. Furthermore, the newly established nomogram model might be better than the TNM (6th revision) staging system but more data needed.ConclusionAggressive treatments, such as surgery, chemotherapy, and radiotherapy, were considered effective for selected elderly patients with EC according to the newly established nomogram model.
Highlights
Esophageal cancer (EC) is a common and lethal carcinoma; the effectiveness and feasibility of the chemo- and radio-therapy (CRT) for the elderly patients (≥ 70 years) with surgery have not been fully discussed
The competing regression and Cox regression models were constructed to identify the patients who received CRT that had lower probabilities of cancer-specific death (CSD) (Fig. 2a, sub-distribution hazard ratio (sHR): 0.55, 95% CI 0.43–0.7, P < 0.001) and better survival outcomes (Fig. 2b, CRT vs. non-CRT, hazard ratio (HR): 0.55, 95% CI 0.45– 0.68, P < 0.001) than those who did not receive CRT
In the present study, based on the post-propensity score matching (PSM) cohort, we found that CRT could have a positive impact on CSD and overall survival (OS) in elderly patients
Summary
Esophageal cancer (EC) is a common and lethal carcinoma; the effectiveness and feasibility of the chemo- and radio-therapy (CRT) for the elderly patients (≥ 70 years) with surgery have not been fully discussed. To improve the quality of life and prolong the survival time, progress on treatments has been made, including minimally invasive surgery for early stage EC [7], neoadjuvant chemotherapy for potentially resectable EC histologically confirmed as squamous cell carcinoma [8] or adenocarcinoma [9] at a locally advanced stage, and immune checkpoint inhibitors for advanced EC [10]. To increase the resection rate in the early stage (T stage > T1), to prolong survival, and to relieve the uncomfortable symptoms in the advanced stage, the combination of chemotherapy and radiotherapy is the most preferred treatment in addition to surgery according to the National Comprehensive Cancer Network guidelines, except for patients with poor physical conditions [11]. With the aging global population, it is urgent to explore the roles of conventional treatments, including chemotherapy and radiotherapy, in elderly patients with EC based on the existing data
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