Prognostic significance of age in the radical treatment of oesophageal cancer with surgery or chemoradiotherapy: a prospective observational cohort study.

Abstract

AIMS:

To compare the outcomes of stage-directed surgical therapy and chemoradiotherapy (CRT) for oesophageal cancer and to determine if a significant age-treatment interaction exists to guide therapy.

MATERIALS AND METHODS:

Five hundred and eight consecutive patients with oesophageal cancer suitable for radical treatment based on radiological stage and performance status were studied (275 surgery; 93 surgery alone, 131 neoadjuvant chemotherapy, 51 neoadjuvant CRT and 233 definitive CRT). The primary measure of outcome was survival.

RESULTS:

Thirty-day mortality rates and 2-year survival after surgery and CRT in patients<70 years were 2.4 and 57.5%, respectively, compared with 0 (P=0.207) and 47.3% (P=0.011), respectively. Thirty-day mortality rates and 2-year survival after surgery and CRT in patients>or=70 years were 7.0 and 45.1%, respectively, compared with 0 (P=0.029) and 46.3% (P=0.992), respectively. Multivariate analysis including only surgical patients in the model revealed three factors to be independently and significantly associated with survival; endoscopic ultrasound (EUS) T stage (P=0.033), EUS lymph node metastasis count (>or=2 versus 0: hazard ratio 1.67, 95% confidence interval 1.06-2.92, P=0.026), and age>or=70 years (hazard ratio 1.51, 95% confidence interval 1.05-2.16, P=0.025).

CONCLUSION:

Overall survival for patients treated with surgery was strongly age dependent around the age of 70 years, and patients>or=70 years with oesophageal cancer should be aware that outcomes after CRT are similar to those after surgery.

• Authors: Ll Davies, W G Lewis, D T Arnold, X Escofet, G Blackshaw, S Gwynne, M Evans, S A Roberts, I Appadurai, T D Crosby
• Journal: Clinical oncology (Royal College of Radiologists (Great Britain)) (Clin Oncol (R Coll Radiol)) Vol. 22 Issue 7 Pg. 578-85 (Sep 2010) ISSN: 1433-2981 [Electronic] England
• PMID: 20591633 (Publication Type: Journal Article)
• Copyright: Copyright (c) 2010 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Epirubicin
• Cisplatin
• Fluorouracil

Topics

• Adenocarcinoma (mortality, pathology, therapy)
• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Carcinoma, Squamous Cell (mortality, pathology, therapy)
• Cisplatin (administration & dosage)
• Cohort Studies
• Combined Modality Therapy
• Epirubicin (administration & dosage)
• Esophageal Neoplasms (mortality, pathology, therapy)
• Esophagectomy
• Female
• Fluorouracil (administration & dosage)
• Humans
• Male
• Middle Aged
• Neoadjuvant Therapy
• Prospective Studies
• Radiotherapy Dosage
• Survival Rate
• Treatment Outcome