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 s...
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| Veröffentlicht in: | Clinical oncology (Royal College of Radiologists (Great Britain)) 2010-09, Vol.22 (7), p.578-585 |
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| creator | Davies, Ll Lewis, W.G Arnold, D.T Escofet, X Blackshaw, G Gwynne, S Evans, M Roberts, S.A Appadurai, I Crosby, T.D |
| description | 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 |
| doi_str_mv | 10.1016/j.clon.2010.05.023 |
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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.</description><identifier>ISSN: 0936-6555</identifier><identifier>EISSN: 1433-2981</identifier><identifier>DOI: 10.1016/j.clon.2010.05.023</identifier><identifier>PMID: 20591633</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adenocarcinoma - mortality ; Adenocarcinoma - pathology ; Adenocarcinoma - therapy ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Carcinoma, Squamous Cell - mortality ; Carcinoma, Squamous Cell - pathology ; Carcinoma, Squamous Cell - therapy ; Cisplatin - administration & dosage ; Cohort Studies ; Combined Modality Therapy ; Epirubicin - administration & dosage ; Esophageal Neoplasms - mortality ; Esophageal Neoplasms - pathology ; Esophageal Neoplasms - therapy ; Esophagectomy ; Female ; Fluorouracil - administration & dosage ; Hematology, Oncology and Palliative Medicine ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; oesophageal cancer ; operative ; prognosis ; Prospective Studies ; Radiology ; Radiotherapy Dosage ; surgical procedures ; Survival Rate ; Treatment Outcome</subject><ispartof>Clinical oncology (Royal College of Radiologists (Great Britain)), 2010-09, Vol.22 (7), p.578-585</ispartof><rights>The Royal College of Radiologists</rights><rights>2010 The Royal College of Radiologists</rights><rights>Copyright (c) 2010 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c410t-f6306a9c504cc97e09e30fafb3cf4408bf88a4b8c31463c138bfcfa18474f2dd3</citedby><cites>FETCH-LOGICAL-c410t-f6306a9c504cc97e09e30fafb3cf4408bf88a4b8c31463c138bfcfa18474f2dd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0936655510001950$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20591633$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Davies, Ll</creatorcontrib><creatorcontrib>Lewis, W.G</creatorcontrib><creatorcontrib>Arnold, D.T</creatorcontrib><creatorcontrib>Escofet, X</creatorcontrib><creatorcontrib>Blackshaw, G</creatorcontrib><creatorcontrib>Gwynne, S</creatorcontrib><creatorcontrib>Evans, M</creatorcontrib><creatorcontrib>Roberts, S.A</creatorcontrib><creatorcontrib>Appadurai, I</creatorcontrib><creatorcontrib>Crosby, T.D</creatorcontrib><title>Prognostic Significance of Age in the Radical Treatment of Oesophageal Cancer with Surgery or Chemoradiotherapy: a Prospective Observational Cohort Study</title><title>Clinical oncology (Royal College of Radiologists (Great Britain))</title><addtitle>Clin Oncol (R Coll Radiol)</addtitle><description>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.</description><subject>Adenocarcinoma - mortality</subject><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - therapy</subject><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Carcinoma, Squamous Cell - mortality</subject><subject>Carcinoma, Squamous Cell - pathology</subject><subject>Carcinoma, Squamous Cell - therapy</subject><subject>Cisplatin - administration & dosage</subject><subject>Cohort Studies</subject><subject>Combined Modality Therapy</subject><subject>Epirubicin - administration & dosage</subject><subject>Esophageal Neoplasms - mortality</subject><subject>Esophageal Neoplasms - pathology</subject><subject>Esophageal Neoplasms - therapy</subject><subject>Esophagectomy</subject><subject>Female</subject><subject>Fluorouracil - administration & dosage</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoadjuvant Therapy</subject><subject>oesophageal cancer</subject><subject>operative</subject><subject>prognosis</subject><subject>Prospective Studies</subject><subject>Radiology</subject><subject>Radiotherapy Dosage</subject><subject>surgical procedures</subject><subject>Survival Rate</subject><subject>Treatment Outcome</subject><issn>0936-6555</issn><issn>1433-2981</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9Uk2P0zAUtBCILQt_gAPyjVOKHTupgxDSqlo-pJWK6HK2HOc5cUniYDtF-Sn8Wxx14cCBk6V5M2O9N4PQS0q2lNDyzWmrezduc5IAUmxJzh6hDeWMZXkl6GO0IRUrs7Ioiiv0LIQTISQXonqKrnJSVLRkbIN-ffGuHV2IVuOjbUdrrFajBuwMvmkB2xHHDvBX1SS8x_ceVBxgjOv8AMFNnWohDfaryOOfNnb4OPsW_IKdx_sOBueT2CUXr6blLVY4fRkm0NGeAR_qAP6sonXj6uI65yM-xrlZnqMnRvUBXjy81-jbh9v7_afs7vDx8_7mLtOckpiZkpFSVbogXOtqB6QCRowyNdOGcyJqI4TitdCM8pJpyhKijaKC77jJm4Zdo9cX38m7HzOEKAcbNPS9GsHNQe64qHaciiIx8wtTpwWCByMnbwflF0mJXBORJ7kmItdEJClkSiSJXj3Yz_UAzV_JnwgS4d2FAGnJswUvg7aQrtlYn44kG2f_7__-H7nu7biG9R0WCCc3-3TZIKkMuSTyuHZirQRNbaBVQdhv02m0yw</recordid><startdate>20100901</startdate><enddate>20100901</enddate><creator>Davies, Ll</creator><creator>Lewis, W.G</creator><creator>Arnold, D.T</creator><creator>Escofet, X</creator><creator>Blackshaw, G</creator><creator>Gwynne, S</creator><creator>Evans, M</creator><creator>Roberts, S.A</creator><creator>Appadurai, I</creator><creator>Crosby, T.D</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20100901</creationdate><title>Prognostic Significance of Age in the Radical Treatment of Oesophageal Cancer with Surgery or Chemoradiotherapy: a Prospective Observational Cohort Study</title><author>Davies, Ll ; Lewis, W.G ; Arnold, D.T ; Escofet, X ; Blackshaw, G ; Gwynne, S ; Evans, M ; Roberts, S.A ; Appadurai, I ; Crosby, T.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c410t-f6306a9c504cc97e09e30fafb3cf4408bf88a4b8c31463c138bfcfa18474f2dd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adenocarcinoma - mortality</topic><topic>Adenocarcinoma - pathology</topic><topic>Adenocarcinoma - therapy</topic><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Carcinoma, Squamous Cell - mortality</topic><topic>Carcinoma, Squamous Cell - pathology</topic><topic>Carcinoma, Squamous Cell - therapy</topic><topic>Cisplatin - administration & dosage</topic><topic>Cohort Studies</topic><topic>Combined Modality Therapy</topic><topic>Epirubicin - administration & dosage</topic><topic>Esophageal Neoplasms - mortality</topic><topic>Esophageal Neoplasms - pathology</topic><topic>Esophageal Neoplasms - therapy</topic><topic>Esophagectomy</topic><topic>Female</topic><topic>Fluorouracil - administration & dosage</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoadjuvant Therapy</topic><topic>oesophageal cancer</topic><topic>operative</topic><topic>prognosis</topic><topic>Prospective Studies</topic><topic>Radiology</topic><topic>Radiotherapy Dosage</topic><topic>surgical procedures</topic><topic>Survival Rate</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Davies, Ll</creatorcontrib><creatorcontrib>Lewis, W.G</creatorcontrib><creatorcontrib>Arnold, D.T</creatorcontrib><creatorcontrib>Escofet, X</creatorcontrib><creatorcontrib>Blackshaw, G</creatorcontrib><creatorcontrib>Gwynne, S</creatorcontrib><creatorcontrib>Evans, M</creatorcontrib><creatorcontrib>Roberts, S.A</creatorcontrib><creatorcontrib>Appadurai, I</creatorcontrib><creatorcontrib>Crosby, T.D</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical oncology (Royal College of Radiologists (Great Britain))</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Davies, Ll</au><au>Lewis, W.G</au><au>Arnold, D.T</au><au>Escofet, X</au><au>Blackshaw, G</au><au>Gwynne, S</au><au>Evans, M</au><au>Roberts, S.A</au><au>Appadurai, I</au><au>Crosby, T.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic Significance of Age in the Radical Treatment of Oesophageal Cancer with Surgery or Chemoradiotherapy: a Prospective Observational Cohort Study</atitle><jtitle>Clinical oncology (Royal College of Radiologists (Great Britain))</jtitle><addtitle>Clin Oncol (R Coll Radiol)</addtitle><date>2010-09-01</date><risdate>2010</risdate><volume>22</volume><issue>7</issue><spage>578</spage><epage>585</epage><pages>578-585</pages><issn>0936-6555</issn><eissn>1433-2981</eissn><abstract>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.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>20591633</pmid><doi>10.1016/j.clon.2010.05.023</doi><tpages>8</tpages></addata></record> |
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| subjects | Adenocarcinoma - mortality Adenocarcinoma - pathology Adenocarcinoma - therapy Adult Age Factors Aged Aged, 80 and over Antineoplastic Combined Chemotherapy Protocols - therapeutic use Carcinoma, Squamous Cell - mortality Carcinoma, Squamous Cell - pathology Carcinoma, Squamous Cell - therapy Cisplatin - administration & dosage Cohort Studies Combined Modality Therapy Epirubicin - administration & dosage Esophageal Neoplasms - mortality Esophageal Neoplasms - pathology Esophageal Neoplasms - therapy Esophagectomy Female Fluorouracil - administration & dosage Hematology, Oncology and Palliative Medicine Humans Male Middle Aged Neoadjuvant Therapy oesophageal cancer operative prognosis Prospective Studies Radiology Radiotherapy Dosage surgical procedures Survival Rate Treatment Outcome |
| title | Prognostic Significance of Age in the Radical Treatment of Oesophageal Cancer with Surgery or Chemoradiotherapy: a Prospective Observational Cohort Study |
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