目的:探讨食管癌切除术是否为可切除的高龄胸椎食管癌患者提供生存优势。

日本国家癌症中心的国家基于医院的癌症登记处数据库中检索了2008年至2011年的数据，将患者分为≥75的组(75-79岁; N = 2935)，≥80岁组(80岁及以上; N = 2131)，比较患者背景和生存曲线。 建立多变量Cox比例风险回归模型，比较两组患者食管切除术和放化疗的效果。 

≥75组(34.6%)接受食管贲门切除术的患者比例明显高于≥80组(18.4%)。 在接受食管切除术的患者中，≥75组3年生存率为51.1%，≥80组3年生存率为39.0% (P < 0.001)。 但在接受放化疗的患者中，两组患者的生存曲线无统计学差异(P = 0.17)。 多变量Cox比例风险分析显示，与放化疗相比，在≥75的临床ii-iii期患者中，食管切除与更好的生存期显著相关(调整后的HR: 0.731) (95%CI: 0.645-0.829, P < 0.001)，而在≥80的组中则没有。

Abstract

Objective: To determine whether esophagectomy provides a survival advantage in octogenarians with resectable thoracic esophageal cancer.

Summary background data: Elderly patients with thoracic esophageal cancer do not always receive the full standard treatment; however, advanced age alone should not preclude the use of effective treatment that could meaningfully improve survival.

Methods: We retrieved the 2008 to 2011 data from the National Database of Hospital-based Cancer Registries from the National Cancer Centerin Japan, divided the patients into a ≥75 group (75-79 years; n = 2935) and a ≥80 group (80 years or older; n = 2131), and then compared the patient backgrounds and survival curves. A multivariable Cox proportional hazards regression model was developed to compare the effects of esophagectomy and chemoradiotherapy in the 2 groups.

Results: A significantly greater percentage of patients were treated with esoph-agectomy in the ≥75 group (34.6%) than the ≥80 group (18.4%). Among patients who received esophagectomy, the 3-year survival rate was 51.1% in the ≥ 75 group and 39.0% in the ≥80 group (P < 0.001). However, among patients who received chemoradiotherapy, there was no difference in survival curve between the 2 groups (P = 0.17). Multivariable Cox proportional hazard analysis revealed that esoph-agectomy for clinical Stage ii-iii patients was significantly associated to better survival (adjusted HR: 0.731) (95%CI: 0.645-0.829, P < 0.001) in the ≥75 group but not the ≥ 80 group when compared with chemoradiotherapy.

Conclusions: Many octogenarians do not necessarily get a survival benefit from esophagectomy. However, patients should be evaluated based on their overall health before ruling out surgery based on age alone.

原文链接

https://pubmed.ncbi.nlm.nih.gov/33630469/

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