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A National Analysis of Treatment Patterns and Outcomes for Patients 80 Years or Older With Esophageal Cancer.
Yang CJ, Wang Y, Raman V, Patel D, Lui N, Backhus L, Shrager J, Berry MF, Liou D. A National Analysis of Treatment Patterns and Outcomes for Patients 80 Years or Older With Esophageal Cancer. Seminars in thoracic and cardiovascular surgery. 2020 Sep 22; 33(3):884-892.
The purpose of this study was to evaluate practice patterns and outcomes for patients 80 years or older with esophageal cancer using a nationwide cancer data base. Practice patterns for patients 80 years or older with stage I-IV esophageal cancer in the National Cancer Data Base from 2004 to 2014 were analyzed. Overall survival associated with different treatment strategies were evaluated using the Kaplan-Meier method and multivariable Cox proportional hazard models. In the study period, 40.5% and 46.2% of patients with stage I adenocarcinoma and squamous cell carcinoma, respectively, did not receive any treatment at all. Less than 11% (196/1,865) of patients with stage I-II disease underwent esophagectomy, even though surgery was associated with a better 5-year survival compared to no treatment (stage I: 47.3% [95% confidence interval [CI] 36.2-57.6%] vs 14.9% [95% CI: 11.2-19.1%]; stage II: 29.3% [95% CI 20.1-39.1%] vs 1.2% [95% CI: 0.1-5.5%]). Of the 1,596 (37.7%) patients with stage III disease who received curative-intent treatment (surgery or chemoradiation), the 5-year survival was significantly better than that of patients who received no treatment (11.9% [95% CI: 9.7-14.4% vs 4.3% [95% CI: 1.9-8.3%]). In this national analysis of patients 80 years and older with esophageal cancer, over 40% of patients with stage I disease did not receive treatment. Patients with stage I-III disease had better survival and risks and benefits of treatment for elderly patients should be discussed in a multidisciplinary setting.