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Guo D, Jin J, Li D, He Y, Lin Y. Analysis of the incidence and mortality trends of esophageal cancer in cancer registry areas of China and Japan. Int J Cancer 2024; 155:1376-1386. [PMID: 38771567 DOI: 10.1002/ijc.35003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/22/2024]
Abstract
This study aims to analyze the prevalence trend of esophageal cancer in Japan and China to provide suggestions for the prevention and treatment of esophageal cancer. The results showed that the incidence rate for the years 2010-2018 significantly decreased with an APC of 5.66%, and the mortality rate from 2010 to 2015 had an APC of -5.87% in China. However, the incidence rate of Japanese women showed an upward trend, with an APC of 4.09% from 2010 to 2019. The mortality rate of esophageal cancer in Japan showed a downward trend, with an APC of -2.96% from 2010 to 2021. From 2010 to 2018, Chinese esophageal squamous cell carcinoma accounted for the highest proportion, accounting for 85.96%, with the largest distribution in the middle, accounting for 47.25%. Patients are mostly diagnosed at stage III, and the relative survival rate from 2012 to 2015 was 30.3%. Japan also has the highest proportion of squamous cell carcinoma, and the lesions are also mostly located in the middle segment. While Japanese esophageal cancer patients are mostly diagnosed at stage I, and the relative survival rate was 41.5% in Japan from 2009 to 2011. The results of this article indicate that the current prevalence of esophageal cancer in China and Japan is generally declining, and the quality of life of patients is gradually improving, but effective screening and prevention strategies are still needed to reduce the burden of this disease.
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Affiliation(s)
- Dongli Guo
- Cancer Institute, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jing Jin
- Cancer Institute, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Daojuan Li
- Cancer Institute, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yutong He
- Cancer Institute, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yingsong Lin
- Department of Public Health, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
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2
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Yao J, Zhao X, Chen J, Liu T, Song Y, Dang J. Treatment strategies for elderly patients with locally advanced esophageal cancer: a systematic review and meta-analysis. BMC Cancer 2024; 24:1101. [PMID: 39232734 PMCID: PMC11373433 DOI: 10.1186/s12885-024-12853-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 08/26/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Neoadjuvant chemoradiotherapy (nCRT) followed by surgery remains a standard of care for resectable esophageal cancer (EC), and definitive chemoradiotherapy (dCRT) is an alternative for unresectable diseases. However, it is controversial for the use of the two aggressive regimens in elderly patients. METHODS We systematically searched multiple databases for studies comparing overall survival (OS) and/or progression-free survival (PFS) between dCRT and surgery (nCRT + surgery or surgery alone) or between dCRT and radiotherapy (RT) alone in elderly patients (age ≥ 65 years) until March 28, 2024. Statistical analysis was performed using random-effects model. RESULTS Fourty-five studies with 33,729 patients were included. dCRT significantly prolonged OS (hazard ratio [HR] = 0.64, 95% confidence interval [CI]: 0.58-0.70) and PFS (HR = 0.67, 95% CI: 0.60-0.76) compared to RT alone for unresectable EC, and resulted in a worse OS compared to surgery for resectable cases (HR = 1.34, 95% CI: 1.23-1.45). Similar results of OS were also observed when the multivariate-adjusted HRs were used as the measure of effect (dCRT vs. RT alone: HR = 0.65, 95% CI: 0.58-0.73; dCRT vs. surgery: HR = 1.49, 95% CI: 1.28-1.74). Subgroup analyses according to age group (≥ 70, ≥ 75, or ≥ 80 years), study design, study region, histological type, radiation field, chemotherapy regimen revealed comparable results. CONCLUSIONS nCRT + surgery is likely a preferred strategy for elderly patients with good physiological conditions; and dCRT is a better alternative for unresectable cases. Advanced age alone does not appear to be a key predictor for the tolerability of the two aggressive treatments.
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Affiliation(s)
- Jiacheng Yao
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Xinyu Zhao
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Jun Chen
- Department of Radiation Oncology, Shenyang Tenth People's Hospital, Shenyang, China
| | - Tingting Liu
- Department of Radiation Oncology, Anshan Cancer Hospital, Anshan, China
| | - Yaowen Song
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China.
| | - Jun Dang
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China.
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Mayanagi S, Inoue M, Tokizawa K, Fushiki K, Tsushima T, Yokota T, Yamazaki K, Yasui H, Tsubosa Y. Survival outcome of esophagectomy and chemoradiotherapy for resectable esophageal squamous cell carcinoma in patients >75 years of age. Thorac Cancer 2024; 15:1656-1664. [PMID: 38898742 PMCID: PMC11260550 DOI: 10.1111/1759-7714.15329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/17/2024] [Accepted: 04/25/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND The gold standard for resectable, locally advanced esophageal squamous cell carcinoma (ESCC) is surgery-based treatment; however, it is unclear whether esophagectomy or chemoradiotherapy is suitable for older patients. This retrospective study aimed to identify the treatment outcomes of surgery-based therapy versus definitive chemoradiotherapy (dCRT) as an initial treatment for older patients with resectable, locally advanced ESCC. METHODS Data from 434 patients who received radical treatment for resectable, locally advanced ESCC were collected from January 2011 to December 2020. Of the patients >75 years of age, 49 underwent radical esophagectomy and 26 received dCRT. Survival was compared between the surgery and dCRT groups. RESULTS The mean ages of the surgery and chemoradiotherapy groups were 77.3 and 78.8 years, respectively. Differences in overall survival (OS) between the two groups were not statistically significant (3-year OS: surgery 66.2%, dCRT 55.7%, p = 0.236). Multivariate analysis for OS showed a hazard ratio of 1.229 for dCRT versus surgery (90% confidence interval 0.681-2.217). OS did not differ between the groups in any of the performance statuses. For patients who were able to receive chemotherapy using fluorouracil and cisplatin, OS tended to be better in the surgery group, but the difference was not statistically significant (3-year OS: surgery 68.1%, dCRT 51.8%, p = 0.117). CONCLUSIONS There was no clear difference in survival outcome between surgery-based therapy and dCRT as an initial treatment for esophageal cancer in older patients. Either treatment may be an option for older patients.
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Affiliation(s)
- Shuhei Mayanagi
- Division of Esophageal SurgeryShizuoka Cancer Center HospitalShizuokaJapan
| | - Masazumi Inoue
- Division of Esophageal SurgeryShizuoka Cancer Center HospitalShizuokaJapan
| | - Kazunori Tokizawa
- Division of Esophageal SurgeryShizuoka Cancer Center HospitalShizuokaJapan
| | - Kunihiro Fushiki
- Division of Gastrointestinal OncologyShizuoka Cancer Center HospitalShizuokaJapan
| | - Takahiro Tsushima
- Division of Gastrointestinal OncologyShizuoka Cancer Center HospitalShizuokaJapan
| | - Tomoya Yokota
- Division of Gastrointestinal OncologyShizuoka Cancer Center HospitalShizuokaJapan
| | - Kentaro Yamazaki
- Division of Gastrointestinal OncologyShizuoka Cancer Center HospitalShizuokaJapan
| | - Hirofumi Yasui
- Division of Gastrointestinal OncologyShizuoka Cancer Center HospitalShizuokaJapan
| | - Yasuhiro Tsubosa
- Division of Esophageal SurgeryShizuoka Cancer Center HospitalShizuokaJapan
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Schiller S, Carmeli I, Orgad R, Kashtan H, Cooper L, Solomon D. Esophagectomy in the Older Adult: A Systematic Review. J Laparoendosc Adv Surg Tech A 2024; 34:464-478. [PMID: 38587375 DOI: 10.1089/lap.2024.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
Current management of esophageal carcinoma (EC) involves combining different modalities, offering the opportunity of personalized strategies. This is particularly enticing in the geriatric population, where tailoring treatment modalities remains key to achieve good outcomes in terms of both quality of life and survival. Primary outcomes of our review included (1) evidence on short-term outcomes following esophagectomy, and (2) evidence on long-term outcomes following esophagectomy. Secondary review questions compared outcomes of (1) neoadjuvant treatment versus upfront surgery for locally advanced esophageal carcinoma, (2) endoscopic submucosal dissection versus esophagectomy for early esophageal carcinoma, and (3) definitive radiation with or without chemotherapy versus surgery. Twenty-six articles were included in the review for the main review questions. Our systematic review underscores the need for comprehensive geriatric evaluations to guide decision-making. Despite concerns about perioperative risks, well-selected older patients can derive survival benefits from surgical intervention.
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Affiliation(s)
| | - Idan Carmeli
- Division of General Surgery, Samson Assuta Ashdod Hospital, Ashdod, Israel
- Faculty of Medicine, Ben Gurion University of the Negev, Beersheba, Israel
| | - Ran Orgad
- Division of General Surgery, Samson Assuta Ashdod Hospital, Ashdod, Israel
| | - Hanoch Kashtan
- Division of General Surgery, Samson Assuta Ashdod Hospital, Ashdod, Israel
- Faculty of Medicine, Ben Gurion University of the Negev, Beersheba, Israel
| | - Lisa Cooper
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Geriatrics, Rabin Medical Center, Petach Tikva, Israel
| | - Daniel Solomon
- Division of General Surgery, Samson Assuta Ashdod Hospital, Ashdod, Israel
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Li K, Li C, Nie X, He W, Du K, Liu K, Wang C, Li J, Han Y, Peng L, Wang Q, Leng X. Surgical vs nonsurgical treatment for esophageal squamous cell carcinoma in patients older than 70 years: a propensity score matching analysis. J Gastrointest Surg 2024; 28:611-620. [PMID: 38704198 DOI: 10.1016/j.gassur.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/01/2024] [Accepted: 01/13/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE With the rising life expectancy and an aging population, it has become increasingly important to investigate treatments suitable for older adult patients with esophageal cancer. This study investigated whether older adult patients who underwent esophagectomy had better clinical outcomes than those who were nonsurgically treated. METHODS We retrospectively analyzed patients with esophageal squamous cell carcinoma (ESCC) who were 70 years or older and underwent esophagectomy, radiotherapy (RT), and/or chemoradiotherapy (CRT) between January 2018 and December 2019. Patients were divided into 2 groups: the surgery group (S group) and the nonsurgery group (NS group). We then compared the clinical outcomes of the 2 groups. RESULTS After a median follow-up duration of 36.6 months, the S group showed better overall survival (OS). The 3-year OS was 59% in the S group and 27% in the NS group (hazard ratio [HR], 0.397; 95% CI, 0.278-0.549; P < .0001). In the S group, the median progression-free survival was 38.3 months (95% CI, 30.6-46.1) compared with 12.3 months in the NS group (HR, 0.511; 95% CI, 0.376-0.695; P < .0001). In addition, the number of adverse events in the NS group was higher than that in the S group (P < .001). CONCLUSION Overall, patients with ESCC at the age of ≥70 years who underwent esophagectomy had significantly better clinical outcomes than those who underwent nonsurgical treatment with RT and/or CRT.
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Affiliation(s)
- Kexun Li
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Sichuan Cancer Hospital, Chengdu, Sichuan; Department of Thoracic Surgery I, Key Laboratory of Lung Cancer of Yunnan Province, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan, Sichuan
| | - Changding Li
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Sichuan Cancer Hospital, Chengdu, Sichuan
| | - Xin Nie
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Sichuan Cancer Hospital, Chengdu, Sichuan
| | - Wenwu He
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Sichuan Cancer Hospital, Chengdu, Sichuan
| | - Kunyi Du
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Sichuan Cancer Hospital, Chengdu, Sichuan
| | - Kun Liu
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Sichuan Cancer Hospital, Chengdu, Sichuan
| | - Chenghao Wang
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Sichuan Cancer Hospital, Chengdu, Sichuan
| | - Jialong Li
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Sichuan Cancer Hospital, Chengdu, Sichuan
| | - Yongtao Han
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Sichuan Cancer Hospital, Chengdu, Sichuan
| | - Lin Peng
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Sichuan Cancer Hospital, Chengdu, Sichuan
| | - Qifeng Wang
- Department of Radiation Oncology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Sichuan Cancer Hospital, Chengdu, Sichuan; Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital, Chengdu, Sichuan
| | - Xuefeng Leng
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Sichuan Cancer Hospital, Chengdu, Sichuan.
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Cooper L, Orgad R, Levi Y, Shmilovitch H, Feferman Y, Solomon D, Kashtan H. Esophageal cancer in octogenarians: Should esophagectomy be done? J Geriatr Oncol 2024; 15:101710. [PMID: 38281389 DOI: 10.1016/j.jgo.2024.101710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/23/2023] [Accepted: 01/22/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION Esophagectomy is the treatment of choice for esophageal cancer. In octogenarians data is conflicting. We evaluated postoperative outcomes and long-term survival of octogenarians and their younger counterparts. MATERIALS AND METHODS A retrospective analysis of a prospectively maintained database including consecutive patients with esophageal cancer who underwent esophagectomy at a large referral, academic center between 2012 and 2021. Subgroups were designed according to age (<70, 70-79, and ≥ 80). RESULTS A total of 359 patients underwent esophagectomy for esophageal cancer, 223 (62%) aged <70, 107 (30%) aged 70-79 and 29 (8%) aged ≥80. Octogenarians had higher American Society of Anesthesiologists [ASA] scores (p = 0.001), and fewer received neoadjuvant therapy (p = 0.04). Octogenarians experienced more major complications (P < 0.001) with significantly higher 30-day mortality rate (P = 0.001). In a multivariable analysis, major complications were associated with higher risk of being discharged to a rehabilitation center (odds ratio [OR] 14.839, 95% confidence interval [CI] 4.921-44.747, p < 0.001) while age was not. Overall survival was reduced in octogenarians, with a 50th percentile survival of 10 months compared to 32 and 26 months in patients age < 70 and 70-79, respectively (p = 0.014). In a multivariable analysis, age ≥ 80 (hazard ratio [HR] 4.478 95% CI 2.151-9.322, p < 0.001), cancer stage (HR 1.545, 95% CI 1.095-2.179, p = 0.013), and postoperative major complications (HR 2.705 95% CI 1.913-3.823, p < 0.001) were independently associated with reduced survival. DISCUSSION Our study showed that octogenarians had significantly higher postoperative major complications compared to younger age groups. Overall survival was significantly reduced in these patients, probably due to an increased rate of perioperative mortality. Better patient selection and preparation may improve postoperative outcomes and increase long-term survival.
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Affiliation(s)
- Lisa Cooper
- Department of Geriatric Medicine, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel..
| | - Ran Orgad
- Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yochai Levi
- Department of Geriatric Medicine, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Hila Shmilovitch
- Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yael Feferman
- Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Daniel Solomon
- Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Hanoch Kashtan
- Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Lv X, Wu X, Liu K, Zhao X, Pan C, Zhao J, Chang J, Guo H, Gao X, Zhi X, Ren C, Chen Q, Jiang H, Wang C, Li Y. Development and Validation of a Nomogram Model for the Risk of Cardiac Death in Patients Treated with Chemotherapy for Esophageal Cancer. Cardiovasc Toxicol 2023; 23:377-387. [PMID: 37804372 DOI: 10.1007/s12012-023-09807-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/05/2023] [Indexed: 10/09/2023]
Abstract
The primary cause of mortality in esophageal cancer survivors is cardiac death. Early identification of cardiac mortality risk during chemotherapy for esophageal cancer is crucial for improving the prognosis. We developed and validated a nomogram model to identify patients with high cardiac mortality risk after chemotherapy for esophageal cancer for early screening and clinical decision-making. We randomly allocated 37,994 patients with chemotherapy-treated esophageal cancer into two groups using a 7:3 split ratio: model training (n = 26,598) and validation (n = 11,396). 5- and 10-year survival rates were used as endpoints for model training and validation. Decision curve analysis and the consistency index (C-index) were used to evaluate the model's net clinical advantage. Model performance was evaluated using receiver operating characteristic curves and computing the area under the curve (AUC). Kaplan-Meier survival analysis based on the prognostic index was performed. Patient risk was stratified according to the death probability. Age, surgery, sex, and year were most closely related to cardiac death and used to plot the nomograms. The C-index for the training and validation datasets were 0.669 and 0.698, respectively, indicating the nomogram's net clinical advantage in predicting cardiac death risk at 5 and 10 years. The 5- and 10-year AUCs were 0.753 and 0.772 for the training dataset and 0.778 and 0.789 for the validation dataset, respectively. The accuracy of the model in predicting cardiac death risk was moderate. This nomogram can identify patients at risk of cardiac death after chemotherapy for esophageal cancer at an early stage.
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Affiliation(s)
- Xinfang Lv
- Department of Geriatrics, Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Lanzhou City, Gansu Province, China
- School of Integrative Medicine, Gansu University of Chinese Medicine, Lanzhou City, Gansu Province, China
| | - Xue Wu
- Department of Cardiology, The Second Hospital of Lanzhou University, Lanzhou City, Gansu Province, China
- School of Integrative Medicine, Gansu University of Chinese Medicine, Lanzhou City, Gansu Province, China
| | - Kai Liu
- School of Integrative Medicine, Gansu University of Chinese Medicine, Lanzhou City, Gansu Province, China
| | - Xinke Zhao
- School of Integrative Medicine, Gansu University of Chinese Medicine, Lanzhou City, Gansu Province, China
| | - Chenliang Pan
- Cardiovascular Disease Center, The First Hospital of Lanzhou University, Lanzhou City, Gansu Province, China
| | - Jing Zhao
- Cardiovascular Disease Center, The First Hospital of Lanzhou University, Lanzhou City, Gansu Province, China
| | - Juan Chang
- Department of Traditional Medicine, Gansu Provincial Hospital, Lanzhou City, Gansu Province, China
| | - Huan Guo
- Center for Translational Medicine, Gansu Provincial Academic Institute for Medical Research, Lanzhou City, Gansu Province, China
| | - Xiang Gao
- School of Integrative Medicine, Gansu University of Chinese Medicine, Lanzhou City, Gansu Province, China
| | - Xiaodong Zhi
- School of Integrative Medicine, Gansu University of Chinese Medicine, Lanzhou City, Gansu Province, China
| | - Chunzhen Ren
- School of Integrative Medicine, Gansu University of Chinese Medicine, Lanzhou City, Gansu Province, China
| | - Qilin Chen
- School of Integrative Medicine, Gansu University of Chinese Medicine, Lanzhou City, Gansu Province, China
| | - Hugang Jiang
- School of Integrative Medicine, Gansu University of Chinese Medicine, Lanzhou City, Gansu Province, China
| | - Chunling Wang
- School of Integrative Medicine, Gansu University of Chinese Medicine, Lanzhou City, Gansu Province, China
| | - Yingdong Li
- School of Integrative Medicine, Gansu University of Chinese Medicine, Lanzhou City, Gansu Province, China.
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Sugawara K, Oka D, Hara H, Yoshii T, Fukuda T. Survival Impacts of Impaired Lung Functions and Comorbidities on Elderly Esophageal Cancer Patients. World J Surg 2023; 47:3229-3239. [PMID: 37798404 DOI: 10.1007/s00268-023-07195-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Preoperative physiological assessments are crucial for optimizing clinical outcomes, especially those of elderly esophageal cancer (EC) patients who are generally frail and at the high risk of mortality. METHODS Patients who underwent surgery for EC between 2004 and 2018 were retrospectively reviewed. Patients were categorized into elderly (>70 years) or non-elderly (≤70 years) groups. Various physiological parameters including the Charlson Comorbidity Index (CCI), immunonutritional parameters and pulmonary functions were studied. Pulmonary functions included %vital capacity (VC) and forced expiratory volume in one second (FEV1.0) and FEV1.0%. The thresholds were set as the lowest quartile (100% for %VC and 2L for FEV1.0) in this cohort. Multivariate Cox hazards models were applied to determine independent predictors of non-EC-related deaths. RESULTS In total, 824 patients were included (elderly; n = 306, non-elderly; n = 518). Elderly patients had a significantly lower 5-year OS rate than non-elderly patients (53.3% vs. 57.2%, P = 0.03), mainly due to increased risk of death from non-EC related causes. In the elderly group, multivariate Cox hazards analysis identified 3 independent predictors of non-EC-related deaths; high CCI (HR 1.98, P=0.006), low %VC (HR 2.01, P = 0.004) and low FEV1.0 (HR 1.6, P=0.048). Elderly patients without risk factors had a significantly better 5-year OS rate (63.5%) than those with 1 (50.0%) or 2-3 (36.3%) risk factors (P <0.01). Deaths due to pulmonary disease rose significantly as the number of risk factors increased (P=0.03). CONCLUSIONS The severity of comorbidities and pulmonary function impairments are useful for predicting long-term outcomes, especially non-EC-related deaths, in elderly EC patients.
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Affiliation(s)
- Kotaro Sugawara
- Department of Gastroenterological Surgery, Saitama Cancer Center, 780 Komuro Inamachi, , Kitaadachi-Gun, Saitama, 362-0806, Japan.
| | - Daiji Oka
- Department of Gastroenterological Surgery, Saitama Cancer Center, 780 Komuro Inamachi, , Kitaadachi-Gun, Saitama, 362-0806, Japan
| | - Hiroki Hara
- Department of Gastroenterology, Saitama Cancer Center, Saitama, Japan
| | - Takako Yoshii
- Department of Gastroenterology, Saitama Cancer Center, Saitama, Japan
| | - Takashi Fukuda
- Department of Gastroenterological Surgery, Saitama Cancer Center, 780 Komuro Inamachi, , Kitaadachi-Gun, Saitama, 362-0806, Japan
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Ahmed N, Tankel J, Asselah J, Alcindor T, Alfieri J, David M, Najmeh S, Spicer J, Cools-Lartigue J, Mueller C, Ferri L. Survival and perioperative outcomes of octo- and nonagenarians with resectable esophageal carcinoma. Dis Esophagus 2023; 36:doad043. [PMID: 37448141 DOI: 10.1093/dote/doad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Indexed: 07/15/2023]
Abstract
The outcomes of different treatment modalities for patients aged 80 and above with locally advanced and resectable esophageal carcinoma are not well described. The aim of this study was to explore survival and perioperative outcomes among this specific group of patients. A retrospective, cohort analysis was performed on a prospectively maintained esophageal cancer database from the McGill regional upper gastroinestinal cancer network. Between 2010 and 2020, all patients ≥80 years with cT2-4a, Nany, M0 esophageal carcinoma were identified and stratified according to the treatment modality: Neoadjuvant chemotherapy (nCT) or chemoradiotherapy (nCRT); definitive CRT (dCRT); upfront surgery; palliative CT/RT; or best supportive care (BSC). Of the 162 patients identified, 79 were included in this study. The median age was 83 years (80-97), most were cT3 (73%), cN- (56%), and had adenocarcinoma (62%). Treatment included: nCT/nCRT (16/79, 20%); surgery alone (19/79, 24%); dCRT (12/29, 15%); palliative RT/CT (27/79, 34%); and BSC (5/79, 6%). Neoadjuvant treatment was completed in 10/16 (63%). Of the 35/79 who underwent surgery, major complications occurred in 13/35 (37%) and 90-day mortality in 3/35 (9%). Overall survival (OS) for the cohort at 1- and 3-years was 58% and 19%. Among patients treated with nCT/nCRT, this was 94% and 46% respectively. Curative intent treatment (nCT/nCRT/upfront surgery/dCRT) had significantly increased 1- and 3- year OS compared with non-curative treatment (76%/31% vs. 34%/3.3%). Multimodal standard of care treatment is feasible and safe in select octo/nonagenarians, and may be associated with improved OS. Age alone should not bias against treatment with curative intent.
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Affiliation(s)
- Nabeel Ahmed
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - James Tankel
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Jamil Asselah
- Division of Medical Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Thierry Alcindor
- Division of Medical Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Joanne Alfieri
- Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marc David
- Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sara Najmeh
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Jonathan Spicer
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Jonathan Cools-Lartigue
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Carmen Mueller
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Lorenzo Ferri
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
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10
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Akkapulu N. Comment on "Does Esophagectomy Provide a Survival Advantage to Patients Aged 80 Years or Older? Analyzing 5066 Patients in the National Database of Hospital-based Cancer Registries in Japan". ANNALS OF SURGERY OPEN 2022; 3:e204. [PMID: 37601149 PMCID: PMC10431542 DOI: 10.1097/as9.0000000000000204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- Nezih Akkapulu
- From the Hacettepe University Department of General Surgery, Hacettepe University Hospital, Ankara, Turkiye
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11
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Hamamoto Y, Murakami K, Kato K, Kitagawa Y. Management of elderly patients with esophageal squamous cell cancer. Jpn J Clin Oncol 2022; 52:816-824. [PMID: 35511482 PMCID: PMC9354502 DOI: 10.1093/jjco/hyac067] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 04/07/2022] [Indexed: 12/02/2022] Open
Abstract
This review focuses on the treatment about elderly esophageal cancer to clarify the current situation regarding our clinical question. Although there are several reviews about elderly esophageal cancer treatment, there are fundamental differences between Japan and the rest of the world. Two main differences are raised: histological differences and treatment strategies for resectable patients. We overview each status according to following clinical questions. First, there are no established evaluation criteria for frail. Second, selection criteria for surgery or non-surgery are not established. Third, few specific treatments for elderly patients (EPs) are investigated. In conclusion, there are many reports about treatment of esophageal squamous cell carcinoma for EPs, although treatment strategy is still controversial. We have to consider well-designed prospective trial to confirm specific treatment strategy according to each stage.
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Grants
- Chugai Pharmaceutical Company, Ltd
- Taiho Pharmaceutical Company, Ltd
- Fujifilm, Toyama Chemical Company, Ltd
- Abbott Japan Company, Ltd
- KCI Licensing, Inc
- Tsumura & Company, Ltd
- Sanofi K.K., Eisai Company, Ltd
- Japan Blood Products Organization Medtronic Japan Company, Ltd
- Nihon Pharmaceutical Company, Ltd
- Ono Pharmaceutical Company, Ltd
- Pfizer Japan, Inc
- Kyouwa Hakkou Kirin Company, Ltd
- Taisho Toyama Pharmaceutical Company, Ltd
- Dainippon Sumitomo Pharma Company, Ltd
- Medicon, Inc
- Astellas Pharma, Inc
- Kowa Pharmaceutical Company, Ltd
- Kaken Pharmaceutical Company, Ltd
- Shionogi Company, Ltd
- Otsuka Pharmaceutical Factory, Inc
- Takeda Pharmaceutical Company, Ltd
- Otsuka Pharmaceutical Company, Ltd
- EA Pharma Company, Ltd
- Asahi Kasei Company, Ltd
- Merck Serono Company, Ltd
- Daiichi Sankyo Company, Ltd
- Yakult Honsha Company, Ltd
- Nihon Pharmaceutical Co, Ltd
- Ono Pharmaceutical Company
- Taisho Toyama Pharmaceutical Company
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Affiliation(s)
- Yasuo Hamamoto
- Keio Cancer Center, Keio University Hospital, School of Medicine, Tokyo, Japan
| | - Kentaro Murakami
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ken Kato
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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12
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Sawada K, Kotani D, Yukami H, Mishima S, Fujiwara H, Kadota T, Nakajo K, Yoda Y, Nakamura M, Hojo H, Yano T, Fujita T, Kojima T. Definitive chemoradiotherapy has comparable survival outcomes to esophagectomy in patients with clinical T1N0M0 esophageal squamous cell carcinoma: real-world data. Int J Clin Oncol 2022; 27:1279-1288. [PMID: 35779118 DOI: 10.1007/s10147-022-02185-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/05/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Recently, the JCOG0502 has shown a comparable efficacy of chemoradiotherapy and esophagectomy in patients with clinical T1N0M0 esophageal squamous cell carcinoma. However, few studies have compared the clinical outcomes of these treatments in esophageal squamous cell carcinoma patients (including elderly patients) based on real-world data. METHODS This retrospective study determined real-world outcomes in patients who underwent chemoradiotherapy or esophagectomy, including those with clinical T1N0M0 esophageal squamous cell carcinoma, between 2009 and 2017 at the National Cancer Center Hospital East. RESULTS Among a total of 156 patients, 120 and 36 patients underwent esophagectomy and chemoradiotherapy, respectively; 138, 12 and 6 patients had Eastern Cooperative Oncology Group performance status 0, 1, and 2, respectively; and 33 and 123 patients had clinical tumor depth MM-SM1 and SM2-SM3, respectively. In a median follow-up of 72 months, 5-year progression-free survival and overall survival were respectively 77.0% and 81.5% in the esophagectomy group and 74.4% and 82.6% in the chemoradiotherapy group (P = 0.48 and, P = 0.89). Moreover, no treatment-related death was detected in both groups. In elderly patients (75 years or older), 5-year progression-free survival and overall survival were not significantly different between esophagectomy and chemoradiotherapy groups (5-year progression-free survival: 72.3% vs. 81.8%, P = 0.38; 5-year overall survival: 76.9% vs. 81.8%, P = 0.59). CONCLUSIONS This real-world study confirms the results of a previous clinical trial, and the present findings support chemoradiotherapy as one of the standard treatment options in patients of all ages with clinical T1N0M0 esophageal squamous cell carcinoma.
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Affiliation(s)
- Kentaro Sawada
- Department of Medical Oncology, Kushiro Rosai Hospital, 13-23 Nakazono-cho, Kushiro, Hokkaido, 085-8533, Japan
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Daisuke Kotani
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
| | - Hiroki Yukami
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Saori Mishima
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Hisashi Fujiwara
- Department of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Tomohiro Kadota
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Keiichiro Nakajo
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Yusuke Yoda
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Masaki Nakamura
- Department of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Hidehiro Hojo
- Department of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Tomonori Yano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Takeo Fujita
- Department of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Takashi Kojima
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
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13
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Zheng C, Luo C, Xie K, Qiang Y, Wang GM, Shen Y. Distinguishing optimal esophagectomy candidates in elderly patients: A nomogram based on propensity score matching. Eur J Surg Oncol 2021; 48:909-916. [PMID: 34952748 DOI: 10.1016/j.ejso.2021.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/19/2021] [Accepted: 12/12/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND A survival benefit from esophagectomy was observed in elderly patients. But it's unclear how to identify specific patients who can benefit. Thus, we aimed to establish a predictive model to identify optimal candidates for esophagectomy. METHODS Patients (age ≥75 years) with esophageal cancer in Surveillance, Epidemiology and End Results (SEER) database were used to establish the predictive model. Propensity-score matching (PSM) was applied to eliminate the imbalance between esophagectomy group and non-esophagectomy group. We hypothesized that elderly patients could benefit from esophagectomy with longer cancer specific survival (CSS) time than those who did not receive esophagectomy. Patients received surgery were divided into beneficial group and non-beneficial group according to the median CSS time of non-esophagectomy group. Prognostic factors affecting patients' long-term survival were identified. Among esophagectomy group, a logistic regression model based on these factors was established to build a nomogram. RESULTS A total of 7,025 eligible patients were extracted from the SEER database, with 831 patients received esophagectomy. Surgery was independently associated with better long-term survival (median CSS time in the matched population: 35 vs. 8 months, p < 0.001). As a result, 361 (68.6%) patients were divided into beneficial group (CSS >8 months). Factors including age, tumor site, histology, differentiation grade, TNM stage, and tumor size were used to formulate the nomogram, which was named as esophagectomy candidates screening score (ECSS). The validation from two aspects showed the model a useful and stable one. CONCLUSION A predictive model was established to distinguish optimal candidates for esophagectomy among elderly patients with EC.
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Affiliation(s)
- Chao Zheng
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Chao Luo
- Department of Cardiothoracic Surgery, Jinling Hospital, Southern Medical University, Guangzhou, China
| | - Kai Xie
- Department of Cardiothoracic Surgery, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Yong Qiang
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Gao-Ming Wang
- Department of Thoracic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China.
| | - Yi Shen
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China; Department of Cardiothoracic Surgery, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, China.
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14
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Motoyama S, Maeda E, Iijima K, Anbai A, Sato Y, Wakita A, Nagaki Y, Fujita H, Minamiya Y, Higashi T. Differences in treatment and survival between elderly patients with thoracic esophageal cancer in metropolitan areas and other areas. Cancer Sci 2021; 112:4281-4291. [PMID: 34288283 PMCID: PMC8486216 DOI: 10.1111/cas.15070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/04/2021] [Accepted: 07/16/2021] [Indexed: 12/25/2022] Open
Abstract
To address the major issue of regional disparity in the treatment for elderly cancer patients in an aging society, we compared the treatment strategies used for elderly patients with thoracic esophageal cancer and their survival outcomes in metropolitan areas and other regions. Using the national database of hospital‐based cancer registries in 2008‐2011, patients aged 75 years or older who had been diagnosed with thoracic esophageal cancer were enrolled. We divided the patients into two groups: those treated in metropolitan areas (Tokyo, Kanagawa, Osaka, Aichi, Saitama, and Chiba prefectures) with populations of 6 million or more and those treated in other areas (the other 41 prefectures). Compared were patient backgrounds, treatment strategies, and survival curves at each cancer stage. In total, 1236 (24%) patients from metropolitan areas and 3830 (76%) patients from nonmetropolitan areas were enrolled. Patients in metropolitan areas were treated at more advanced stages. There was also a difference in treatment strategy. The 3‐year survival rate among cStage I patients was better in metropolitan areas (71.6% vs. 63.7%), and this finding mainly reflected the survival difference between patients treated with radiotherapy alone. For cStage II‐IV patients, there were no differences. Multivariable Cox proportional hazard analysis including interaction terms between treatment areas, cStage, and the first‐line treatments revealed that treatments in the metropolitan areas were significantly associated with better survival among patients treated with radiotherapy alone for cStage I cancer. Treatment strategies for elderly patients with thoracic esophageal cancer and its survival outcomes differed between metropolitan areas and other regions.
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Affiliation(s)
- Satoru Motoyama
- Division of Esophageal Surgery, Akita University Hospital, Akita, Japan.,Department of Comprehensive Cancer Control, Akita University Graduate School of Medicine, Akita, Japan
| | - Eri Maeda
- Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan
| | - Katsunori Iijima
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan
| | - Akira Anbai
- Department of Radiology, Akita University Graduate School of Medicine, Akita, Japan
| | - Yusuke Sato
- Division of Esophageal Surgery, Akita University Hospital, Akita, Japan.,Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Akiyuki Wakita
- Division of Esophageal Surgery, Akita University Hospital, Akita, Japan.,Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yushi Nagaki
- Division of Esophageal Surgery, Akita University Hospital, Akita, Japan.,Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiromu Fujita
- Division of Esophageal Surgery, Akita University Hospital, Akita, Japan.,Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshihiro Minamiya
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Takahiro Higashi
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, Akita University Graduate School of Medicine, Akita, Japan
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