Long-term survival of surgical versus non-surgical treatment for esophageal squamous cell carcinoma in patients ≥70 years: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Kexun ¹ , LI Changding ¹ , NIE Xin ¹ , HE Wenwu ¹ , WANG Chenghao ¹ , WANG Kangning ¹ , LIU Guangyuan ¹ , CHEN Junqiang ² , XIAO Zefen ³ , FANG Qiang ¹ , HAN Yongtao ¹ , PENG Lin ¹ ,  WANG Qifeng ⁴ ,  LENG Xuefeng ¹

1. Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, P. R. China;
2. Department of Radiation Oncology, Fujian Provincial Tumor Hospital, Fujian Medical University, Fuzhou, 350014, P. R. China;
3. Department of Radiation Oncology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, 100021, P. R. China;
4. Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, P. R. China;

Corresponding author：

WANG Qifeng, Email: littlecancer@163.com; LENG Xuefeng, Email: doc.leng@uestc.edu.cn

Keywords：

Esophageal squamous cell carcinoma; surgical treatment; conservative treatment; overall survival; elderly patients

DOI：

10.7507/1007-4848.202403062

Video：

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Objective To compare the long-term survival of elderly patients with esophageal squamous cell carcinoma (ESCC) treated with surgical versus non-surgical treatment. Methods A retrospective analysis was conducted on the clinical data of elderly patients aged ≥70 years with ESCC who underwent esophagectomy or radiotherapy/chemotherapy at Sichuan Cancer Hospital from January 2009 to September 2017. Patients were divided into a surgical group (S group) and a non-surgical group (NS group) according to the treatment method. The propensity score matching method was used to match the two groups of patients at a ratio of 1:1, and the survival of the two groups before and after matching was analyzed. Results A total of 726 elderly patients with ESCC were included, including 552 males and 174 females, with 651 patients aged 70-79 years and 75 patients aged≥80 years. There were 515 patients in the S group and 211 patients in the NS group. The median follow-up time was 60.8 months, and the median overall survival of the S group was 41.9 months [95%CI (35.2, 48.5)], while that of the NS group was only 24.0 months [95%CI (19.8, 28.3)]. The 1-, 3-, and 5-year overall survival rates of the S group were 84%, 54%, and 40%, respectively, while those of the NS group were 72%, 40%, and 30%, respectively [HR=0.689, 95%CI (0.559, 0.849), P<0.001]. After matching, 138 patients were included in each group, and there was no statistical difference in the overall survival between the two groups [HR=0.871, 95%CI (0.649, 1.167), P=0.352]. Conclusion Compared with conservative treatment, there is no significant difference in the long-term survival of elderly patients aged≥70 years who undergo esophagectomy for ESCC. Neoadjuvant therapy combined with surgery is still an important choice to potentially improve the survival of elderly patients with ESCC.

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21.	Kranzfelder M, Schuster T, Geinitz H, et al. Meta-analysis of neoadjuvant treatment modalities and definitive non-surgical therapy for oesophageal squamous cell cancer. Br J Surg, 2011, 98(6): 768-783.
22.	Li B, Zhang Y, Miao L, et al. Esophagectomy with three-field versus two-field lymphadenectomy for middle and lower thoracic esophageal cancer: Long-term outcomes of a randomized clinical trial. J Thorac Oncol, 2021, 16(2): 310-317.
23.	Hu Y, Hu C, Zhang H, et al. How does the number of resected lymph nodes influence TNM staging and prognosis for esophageal carcinoma? Ann Surg Oncol, 2010, 17(3): 784-790.
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25.	Cheng D, Zhao W, Chen R, et al. Neoadjuvant PD-1 blockade combined with chemotherapy is not superior to neoadjuvant chemotherapy alone in resectable locally advanced esophageal carcinoma. World J Surg Oncol, 2023, 21(1): 33.

1. Siegel RL, Miller KD, Wagle NS, et al. Cancer statistics, 2023. CA Cancer J Clin, 2023, 73(1): 17-48.
2. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
3. Yuan P, Xiang J, Borg M, et al. Analysis of lifetime death probability for major causes of death among residents in China. BMC Public Health, 2020, 20(1): 1090.
4. National Cancer Institute. SEER cancer stat facts: Esophageal cancer. https://seer.cancer.gov/statfacts/html/esoph.html. Accessed on January 20, 2021.
5. Vlacich G, Samson PP, Perkins SM, et al. Treatment utilization and outcomes in elderly patients with locally advanced esophageal carcinoma: A review of the National Cancer Database. Cancer Med, 2017, 6(12): 2886-2896.
6. Yang H, Liu H, Chen Y, et al. Neoadjuvant chemoradiotherapy followed by surgery versus surgery alone for locally advanced squamous cell carcinoma of the esophagus (NEOCRTEC5010): A phaseⅢmulticenter, randomized, open-label clinical trial. J Clin Oncol, 2018, 36(27): 2796-2803.
7. Kelly RJ, Ajani JA, Kuzdzal J, et al. Adjuvant nivolumab in resected esophageal or gastroesophageal junction cancer. N Engl J Med, 2021, 384(13): 1191, 1203.
8. Li C, Zhao S, Zheng Y, et al. Preoperative pembrolizumab combined with chemoradiotherapy for oesophageal squamous cell carcinoma (PALACE-1). Eur J Cancer, 2021, 144: 232-241.
9. National Comprehensive Cancer Network. The NCCN esophageal and esophagogastric junction cancers clinical practice guidelines in oncology (version 1.2023). http://www.nccn.org/professionals/ physician_gls/f_guidelines.asp. Accessed on July 10, 2023.
10. Li K, Du K, Liu K, et al. Impact of two-field or three-field lymphadenectomy on overall survival in middle and lower thoracic esophageal squamous cell carcinoma: A single-center retrospective analysis. Oncol Lett, 2023, 25(5): 189.
11. Li K, Leng X, He W, et al. Resected lymph nodes and survival of patients with esophageal squamous cell carcinoma: An observational study. Int J Surg, 2023, 109(7): 2001-2009.
12. Li K, Nie X, Li C, et al. Mapping of lymph node metastasis and efficacy index in thoracic esophageal squamous cell carcinoma: A large-scale retrospective analysis. Ann Surg Oncol, 2023, 30(9): 5856-5865.
13. Wang X, Han W, Zhang W, et al. Effectiveness of S-1-based chemoradiotherapy in patients 70 years and older with esophageal squamous cell carcinoma: A randomized clinical trial. JAMA Netw Open, 2023, 6(5): e2312625.
14. Wang X, Ge X, Wang X, et al. S-1-based chemoradiotherapy followed by consolidation chemotherapy with S-1 in elderly patients with esophageal squamous cell carcinoma: A multicenter phaseⅡtrial. Front Oncol, 2020, 10: 1499.
15. Bedenne L, Michel P, Bouché O, et al. Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol, 2007, 25(10): 1160-1168.
16. W Yan, Zhao P, Fu H, et al. Survival after induction chemotherapy and esophagectomy is not improved by adjuvant chemotherapy. Ann Thorac Surg, 2019, 108(5): 1505-1513.
17. Wang BY, Hung WH, Wu SC, et al. Comparison between esophagectomy and definitive chemoradiotherapy in patients with esophageal cancer. Ann Thorac Surg, 2019, 107(4): 1060-1067.
18. Nomura M, Oze I, Kodaira T, et al. Comparison between surgery and definitive chemoradiotherapy for patients with resectable esophageal squamous cell carcinoma: A propensity score analysis. Int J Clin Oncol, 2016, 21(5): 890-898.
19. Li K, Li C, Nie X, et al. 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(5): 611-620.
20. Shapiro J, van Lanschot JJB, Hulshof MCCM, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): Long-term results of a randomised controlled trial. Lancet Oncol, 2015, 16(9): 1090-1098.
21. Kranzfelder M, Schuster T, Geinitz H, et al. Meta-analysis of neoadjuvant treatment modalities and definitive non-surgical therapy for oesophageal squamous cell cancer. Br J Surg, 2011, 98(6): 768-783.
22. Li B, Zhang Y, Miao L, et al. Esophagectomy with three-field versus two-field lymphadenectomy for middle and lower thoracic esophageal cancer: Long-term outcomes of a randomized clinical trial. J Thorac Oncol, 2021, 16(2): 310-317.
23. Hu Y, Hu C, Zhang H, et al. How does the number of resected lymph nodes influence TNM staging and prognosis for esophageal carcinoma? Ann Surg Oncol, 2010, 17(3): 784-790.
24. Kato K, Yoshinori I, Hiroyuki D, et al. A randomized controlled phaseⅢtrial comparing two chemotherapy regimen and chemoradiotherapy regimen as neoadjuvant treatment for locally advanced esophageal cancer, JCOG1109 NExT study. J Clin Oncol, 2022, 40(4_suppl): 238.
25. Cheng D, Zhao W, Chen R, et al. Neoadjuvant PD-1 blockade combined with chemotherapy is not superior to neoadjuvant chemotherapy alone in resectable locally advanced esophageal carcinoma. World J Surg Oncol, 2023, 21(1): 33.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesLong-term survival of surgical versus non-surgical treatment for esophageal squamous cell carcinoma in patients ≥70 years: A retrospective cohort study

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