Yuan Zeng1,2, Wenhua Liang1,2, Jun Liu1,2, Jiaxi He1,2, Calvin S H Ng3, Chia-Chuan Liu4, René Horsleben Petersen5, Gaetano Rocco6, Thomas D'Amico7, Alessandro Brunelli8, Haiquan Chen9, Xiuyi Zhi10, Xiao Dong11, Wei Wang1,12, Fei Cui1,2, Dakai Xiao1,12, Wenjun Wang1,12, Wei Yang11, Hui Pan1,2, Jianxing He1,2. 1. Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China. 2. Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China. 3. Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China. 4. Division of thoracic surgery, Sun Yat-Sen Cancer Center, Taipei. 5. Department of Cardiothoracic Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark. 6. Division of Thoracic Surgical Oncology, Department of Thoracic Surgery and Oncology, Istituto Nazionale Tumori, IRCCS, Fondazione Pascale, Naples, Italy. 7. Section of General Thoracic Surgery, Duke University Medical Center, Durham, NC, USA. 8. Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK. 9. Department of Thoracic Surgery, Fudan University Shanghai, china Cancer Center, Shanghai 200032, China. 10. Department of Thoracic Surgery, Beijing Xuanwu Hospital of Capital Medical University, Beijing 100053, China. 11. Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330008, China. 12. Research Center for Translational Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
Abstract
BACKGROUND: As the aging issue and increased elderly esophageal cancer (EC) patients, we sought to study the clinical characteristics, treatment modality and outcomes of EC patients 70 years or older compared with those younger than 70 years old. METHODS: The national surveillance, epidemiology, and end results (SEER) database for the period from 1973 to 2013 was analyzed. The patient and treatment characteristics were compared between the age groups. Multivariate Cox proportional hazard regression analyses were also performed to identify independent prognostic factors. Propensity-score matching analyses (PSA) regarding survival after different treatments were also performed in locoregional EC. RESULTS: Compared with the younger group, patients 70 years or older were characterized by having a higher proportion of patients with female gender, white race, localized disease, non-adenocarcinoma and without any treatment, as well as inferior overall survival (OS) [hazard ratio (HR), 1.324] and EC-specific survival (HR, 1.270). In addition, older patients shared same independent prognostic factors with younger patients, including age, histology and race. Specifically, compared with those receiving no intensive treatments, surgery alone (HR, 0.342), both surgery and RT (HR, 0.323) and RT only (HR, 0.525) were favorable among elderly patients, as confirmed by both multivariate adjustment and PSA. CONCLUSIONS: Compared to younger EC patients, those 70 years or older showed distinctive clinical characteristics and inferior survival. Despite showing a higher proportion of localized disease, patients 70 years or older were less likely to be subjected to surgery or/and RT. Thus, the role of intensive treatments, which were identified as favorable factors among elderly patients in this study, warrants further investigation.
BACKGROUND: As the aging issue and increased elderly esophageal cancer (EC) patients, we sought to study the clinical characteristics, treatment modality and outcomes of EC patients 70 years or older compared with those younger than 70 years old. METHODS: The national surveillance, epidemiology, and end results (SEER) database for the period from 1973 to 2013 was analyzed. The patient and treatment characteristics were compared between the age groups. Multivariate Cox proportional hazard regression analyses were also performed to identify independent prognostic factors. Propensity-score matching analyses (PSA) regarding survival after different treatments were also performed in locoregional EC. RESULTS: Compared with the younger group, patients 70 years or older were characterized by having a higher proportion of patients with female gender, white race, localized disease, non-adenocarcinoma and without any treatment, as well as inferior overall survival (OS) [hazard ratio (HR), 1.324] and EC-specific survival (HR, 1.270). In addition, older patients shared same independent prognostic factors with younger patients, including age, histology and race. Specifically, compared with those receiving no intensive treatments, surgery alone (HR, 0.342), both surgery and RT (HR, 0.323) and RT only (HR, 0.525) were favorable among elderly patients, as confirmed by both multivariate adjustment and PSA. CONCLUSIONS: Compared to younger EC patients, those 70 years or older showed distinctive clinical characteristics and inferior survival. Despite showing a higher proportion of localized disease, patients 70 years or older were less likely to be subjected to surgery or/and RT. Thus, the role of intensive treatments, which were identified as favorable factors among elderly patients in this study, warrants further investigation.
Entities:
Keywords:
Esophageal cancer (EC); elderly; propensity-score matching analyses (PSA); surveillance, epidemiology, and end results (SEER)
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