Esophagectomy compared with chemoradiation for early stage esophageal cancer in the elderly.
Esophagectomy compared with chemoradiation for early stage esophageal cancer in the elderly.
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DOI：
10.1002/cncr.24536
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发表时间：
2009-11-01
期刊：
影响因子：
6.2
通讯作者：
Neugut, Alfred I.
中科院分区：
文献类型：
--
作者：
Abrams, Julian A.;Buono, Donna L.;Strauss, Joshua;McBride, Russell B.;Hershman, Dawn L.;Neugut, Alfred I.
关键词：
食管切除术一直是早期食管癌的传统首选治疗方法。然而，对于老年人来说，食管切除术具有较高的死亡率和发病率，这些患者往往接受放化疗来替代。我们在一个基于人群的老年早期食管癌患者样本中比较了食管切除术和放化疗的结果。
我们使用监测、流行病学和最终结果 - 医疗保险（SEER - Medicare）数据库来确定1991 - 2002年期间被诊断为1期或2期食管癌的65岁及以上患者。我们评估了食管切除术或放化疗治疗与人口统计学和临床变量之间的关联。我们进行了生存分析，以比较不同治疗方式的结果，并对潜在的混杂因素进行了调整。
我们确定了730例1期或2期食管癌患者，其中341例（46.7%）接受了食管切除术，389例（53.3%）接受了放化疗。年龄较大、鳞状细胞组织学类型以及较低的社会经济地位与接受放化疗的几率增加有关。在多变量分析中，放化疗与更差的疾病特异性生存率（风险比2.08，95%置信区间1.64 - 2.64）和总生存率（风险比1.92，95%置信区间1.58 - 2.34）相关。接受放化疗与腺癌患者更差的生存率相关（风险比3.01，95%置信区间2.24 - 4.04），但对于鳞状细胞癌患者没有显著差异（风险比1.33，95%置信区间0.98 - 1.80）。
与放化疗相比，食管切除术可能与老年早期食管癌患者生存率的提高有关。结果表明，可能也有一部分鳞状细胞癌患者，放化疗对他们来说是足够的治疗方法。一项随机试验将有助于确定老年早期食管癌患者的最佳治疗方法。
Esophagectomy has been the traditional treatment of choice for early stage esophageal cancer. However, esophagectomy is associated with high mortality and morbidity in the elderly, and these patients often receive chemoradiation instead. We compared outcomes of esophagectomy versus chemoradiation in a population-based sample of elderly patients with early stage esophageal cancer. We used the Surveillance, Epidemiology, and End Results-Medicare database to identify patients ≥65 years diagnosed with stage 1 or 2 esophageal cancer from 1991–2002. We assessed associations of treatment with esophagectomy or chemoradiation with demographic and clinical variables. We performed survival analyses to compare outcomes with treatment modality, adjusted for potential confounders. We identified 730 patients with stage 1 or 2 esophageal cancer who underwent esophagectomy (n=341; 46.7%) or chemoradiation (n=389, 53.3%). Older age, squamous cell histology, and lower socioeconomic status were associated with increased odds of receipt of chemoradiation. In multivariable analyses, chemoradiation was associated with worse disease-specific (HR 2.08, 95%CI 1.64–2.64) and overall survival (HR 1.92, 95%CI 1.58–2.34). Receipt of chemoradiation was associated with worse survival for adenocarcinoma (HR 3.01, 95%CI 2.24–4.04), but there was no significant difference for squamous cell (HR 1.33, 95%CI 0.98–1.80). Compared to chemoradiation, esophagectomy may be associated with improved survival for early stage esophageal cancer in the elderly. The results suggest that there may also be a subset of squamous cell patients for whom chemoradiation is adequate therapy. A randomized trial would be useful to determine optimal treatment for elderly patients with early stage esophageal cancer.
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