Long-term Outcomes of Treatment Patterns and Survival for Esophageal Squamous Cell Carcinoma Over than 70 Years: A Multicenter Analysis of 726 Cases

Abstract

Abstract Purpose: The main focus of this study is to investigate the impact of esophagectomy on the survival of elderly patients with esophageal squamous cell carcinoma (ESCC) in East Asia. Our team conducted this study to investigate whether comprehensive treatment based on surgery is suitable for elderly patients with ESCC and whether it provides an overall survival (OS) benefit. Methods: To conduct this research, we collected data from two databases: the Sichuan Cancer Hospital & Institute Esophageal Cancer Case Management Database (SCCH-ECCM Database) and the department of radiation oncology multicenter database. A retrospective analysis was performed on ESCC patients aged 70 years or older, who underwent either esophagectomy or received radiotherapy/chemotherapy between January 2009 and December 2017. The patients were categorized into two groups: the upfront surgery group (referred to as the S group) and the non-surgery group (referred to as the NS group). Results: The median follow-up period was 60.8 months. The S group exhibited a median overall survival (OS) of 41.9 months (95% CI, 35.2-48.5), whereas the NS group demonstrated a significantly lower median OS of only 24.0 months (95% CI, 19.8-28.3). The survival rates at 1, 3, and 5 years in the S group were 84%, 54%, and 40% respectively. Conversely, the NS group had lower survival rates at 1, 3, and 5 years, which were 72%, 40%, and 30%, respectively (HR, 0.689; 95% CI, 0.559-0.849; P＜0.0001). However, after employing propensity score matching (PSM), we did not observe a significant difference in OS between the two groups (HR, 0.871; 95% CI, 0.649–1.167; P=0.352). Conclusion: For ESCC patients aged 70 years or older, our findings suggest that upfront esophagectomy does not significantly improve overall survival compared to non-surgical treatment involving radiotherapy and/or chemotherapy.