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 ≥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 (≥2 versus 0: hazard ratio 1.67, 95% confidence interval 1.06–2.92, P=0.026), and age ≥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 ≥70 years with oesophageal cancer should be aware that outcomes after CRT are similar to those after surgery.

Key words: Age factors, oesophageal cancer, operative, prognosis, surgical procedures