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

Ll Davies, W G Lewis, D T Arnold, X Escofet, G Blackshaw, S Gwynne, M Evans, S A Roberts, I Appadurai, T D Crosby

Research output: Contribution to journalArticle (Academic Journal)peer-review

12 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)578-85
Number of pages8
JournalClinical Oncology
Volume22
Issue number7
DOIs
Publication statusPublished - Sep 2010

Keywords

  • Adenocarcinoma
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Antineoplastic Combined Chemotherapy Protocols
  • Carcinoma, Squamous Cell
  • Cisplatin
  • Cohort Studies
  • Combined Modality Therapy
  • Epirubicin
  • Esophageal Neoplasms
  • Esophagectomy
  • Female
  • Fluorouracil
  • Humans
  • Male
  • Middle Aged
  • Neoadjuvant Therapy
  • Prospective Studies
  • Radiotherapy Dosage
  • Survival Rate
  • Treatment Outcome
  • Journal Article

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