DO ELDERLY PATIENTS EXPERIENCE INCREASED PERIOPERATIVE OR POSTOPERATIVE MORBIDITY OR MORTALITY WHEN GIVEN NEOADJUVANT CHEMORADIATION BEFORE ESOPHAGECTOMY?
DO ELDERLY PATIENTS EXPERIENCE INCREASED PERIOPERATIVE OR POSTOPERATIVE MORBIDITY OR MORTALITY WHEN GIVEN NEOADJUVANT CHEMORADIATION BEFORE ESOPHAGECTOMY?
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DOI：
10.1016/j.ijrobp.2010.04.055
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发表时间：
2011-08-01
影响因子：
7
通讯作者：
Berger, Adam C.
中科院分区：
文献类型：
--
作者：
Fogh, Shannon E.;Yu, Anthony;Berger, Adam C.
背景：手术后诱导放化疗已广泛用于食管癌的治疗。该方案术后发病率和死亡率增加的假定风险导致不愿向老年患者提供该治疗。我们比较了70岁及以上患者的围手术期发病率和死亡率与年龄小于70岁的患者接受CRT，其次是食管切除术，并试图确定术前风险因素，可能预测术后死亡或并发症的风险较高。方法和材料：我们确定了260例患者进行术前放化疗，其次是食管切除术。对年龄与术后死亡和并发症的关系进行了评估。Charlson指数、既往心脏病史和糖尿病被确定为术前风险因素，并被评估为潜在的混杂因素或影响因素。心脏病和Charlson指数是年龄对住院时间影响的潜在修正因素（分别为p = 0.08和p = 0.07）和术后并发症（p = 0.1和p = 0.2），但无统计学显著性。有一个轻微的非显着降低老年患者的死亡风险调整后的Charlson指数（p = 0.2）。结论：老年患者的发病率和死亡率没有显着差异。心脏病、Charlson指数评分较高或糖尿病的存在对住院时间、术后并发症或术后死亡没有显著影响。考虑到改善结局的潜力，该方案不应在老年患者中被忽视。(C)2011 Elsevier Inc.
Background: The use of induction chemoradiotherapy followed by surgery has been widely used for the treatment of esophageal cancer. The presumed risk of increased postoperative morbidity and mortality with this regimen has led to reluctance to offer this therapy to elderly patients. We compared the perioperative morbidity and mortality of patients 70 years old and older with those of patients younger than 70 who received CRT followed by esophagectomy and sought to identify preoperative risk factors that may predict higher risk of postoperative death or complications.Methods and Materials: We identified 260 patients who underwent preoperative chemoradiotherapy followed by esophagectomy. The association of age with postoperative death and complications was evaluated. The Charlson index, prior cardiac history, and diabetes were identified as preoperative risk factors and were evaluated as potential confounders or effect modifiers.Results: Cardiac disease and the Charlson index were potential modifiers of the effect of age on length of hospital stay (p = 0.08 and p = 0.07, respectively) and postoperative complications (p = 0.1 and p = 0.2) but were not statistically significant. There was a slight nonsignificant decrease in the risk of death in elderly patients after adjustment for the Charlson index (p = 0.2).Conclusion: No significant differences were detected with respect to morbidity and mortality in elderly patients. The presence of cardiac disease, higher scores on the Charlson index, or diabetes did not significantly influence length of stay, postoperative complications, or postoperative death. Given the potential to improve outcomes, this regimen should not be discounted in elderly patients. (C) 2011 Elsevier Inc.