Skip to main content
SpringerLink
Log in

Impact of the Charlson Comorbidity Index on the treatment strategy and survival in elderly patients after non-curative endoscopic submucosal dissection for esophageal squamous cell carcinoma: a multicenter retrospective study

  • Original Article—Alimentary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

In elderly patients with superficial esophageal squamous cell carcinoma (ESCC), the optimal treatment strategy after non-curative endoscopic submucosal dissection (ESD) remains unclear. We aimed to evaluate the validity of additional treatments after non-curative ESD and post-ESD survival predictors in elderly patients with ESCC.

Methods

Elderly patients (age > 75 years) treated with ESD for ESCC between January 2010 and July 2014 at six tertiary referral hospitals in Japan were retrospectively investigated and stratified according to lymph node metastasis risk, based on histological findings (high-risk factors: positive lymphovascular invasion, submucosal invasion, and positive/indeterminate vertical margin) and post-ESD treatment strategy: group A (287 patients; low risk), group B (41 patients; high risk, without additional treatment), and group C (32 patients; high risk, with additional treatment). We evaluated 3- and 5-year overall survival and disease-specific survival, and prognostic factors for post-ESD survival.

Results

At a median follow-up of 38, 40, and 49 months, respectively, there was 1 esophageal cancer-related death in group A, 1 in group B, and none in group C, whereas 22, 9, and 3 patients in groups A, B, and C died of other diseases. The groups differed significantly in overall survival (92.4%; 87.6%; 93.4%, p = 0.022), although not in disease-specific survival (99.4%; 96.3%; 100%, p = 0.217). On multivariate analysis, Charlson Comorbidity Index (CCI) ≥ 2 was the only independent risk factor for post-ESD death (hazard ratio 7.92; 95% confidence interval 3.42–18.3; p < 0.001).

Conclusions

A follow-up strategy without additional treatment after ESD for ESCC may be acceptable in high-risk elderly patients, especially for CCI ≥ 2.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Oyama T, Tomori A, Hotta K, et al. Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol. 2005;3:S67–70.

    Article  Google Scholar 

  2. Fujishiro M, Yahagi N, Kakushima N, et al. Endoscopic submucosal dissection of esophageal squamous cell neoplasms. Clin Gastroenterol Hepatol. 2006;4:688–94.

    Article  Google Scholar 

  3. Ishihara R, Iishi H, Uedo N, et al. Comparison of EMR and endoscopic submucosal dissection for en bloc resection of early esophageal cancers in Japan. Gastrointest Endosc. 2008;68:1066–72.

    Article  Google Scholar 

  4. Takahashi H, Arimura Y, Masao H, et al. Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus. Gastrointest Endosc. 2010;72:255–64.

    Article  Google Scholar 

  5. Greenstein AJ, Litle VR, Swanson SJ, et al. Effect of the number of lymph nodes sampled on postoperative survival of lymph node-negative esophageal cancer. Cancer. 2008;112:1239–46.

    Article  Google Scholar 

  6. The Japanese Society for Esophageal Diseases. Comprehensive registry of esophageal cancer in Japan (1998, 1999) and long-term results of esophagectomy in Japan (1988–1997). 3rd ed. Chiba: The Japanese Society for Esophageal Diseases; 2002.

    Google Scholar 

  7. Katada C, Muto M, Momma K, et al. Clinical outcome after endoscopic mucosal resection for esophageal squamous cell carcinoma invading the muscularis mucosae—a multicenter retrospective cohort study. Endoscopy. 2007;39:779–83.

    Article  CAS  Google Scholar 

  8. Shimizu Y, Tsukagoshi H, Fujita M, et al. Long-term outcome after endoscopic mucosal resection in patients with esophageal squamous cell carcinoma invading the muscularis mucosae or deeper. Gastrointest Endosc. 2002;56:387–90.

    Article  Google Scholar 

  9. Motoyama S, Jin M, Matsuhashi T, et al. Outcome of patients receiving additional esophagectomy after endoscopic resection for clinically mucosal, but pathologically submucosal, squamous cell carcinoma of the esophagus. Surg Today. 2013;43:638–42.

    Article  Google Scholar 

  10. Ikeda A, Hoshi N, Yoshizaki T, et al. Endoscopic submucosal dissection (ESD) with additional therapy for superficial esophageal cancer with submucosal invasion. Intern Med. 2015;54:2803–13.

    Article  Google Scholar 

  11. Kurokawa Y, Muto M, Minashi K, et al. A phase II trial of combined treatment of endoscopic mucosal resection and chemoradiotherapy for clinical stage I esophageal carcinoma: Japan Clinical Oncology Group Study (JCOG0508). Jpn J Clin Oncol. 2009;39:686–9.

    Article  Google Scholar 

  12. Shimizu Y, Kato M, Yamamoto J, et al. EMR combined with chemoradiotherapy: a novel treatment for superficial esophageal squamous cell carcinoma. Gastrointest Endosc. 2004;59:199–204.

    Article  Google Scholar 

  13. Kikuchi O, Mouri H, Matsueda K, et al. Endoscopic submucosal dissection for treatment of patients aged 75 years and over with esophageal cancer. ISRN Gastroenterol. 2012;2012:671324.

    Article  Google Scholar 

  14. Peng C, Shen S, Xu G, et al. Efficacy and safety of endoscopic submucosal dissection for elderly patients with superficial squamous esophageal neoplasms. United Eur Gastroenterol J. 2016;4:242–9.

    Article  CAS  Google Scholar 

  15. Sekiguchi M, Oda I, Suzuki H, et al. Clinical outcomes and prognostic factors in gastric cancer patients aged ≥85 years undergoing endoscopic submucosal dissection. Gastrointest Endosc. 2017;85:963–72.

    Article  Google Scholar 

  16. Centers for Disease Control and Prevention. Public health and aging: trends in aging—United States and worldwide. JAMA. 2003;289:1371–3.

    Article  Google Scholar 

  17. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.

    Article  CAS  Google Scholar 

  18. Japan Esophageal Society. Guideline for clinical and pathological studies on carcinoma of the esophagus. 10th ed. Tokyo: Kanehara & Co., Ltd.; 2007.

    Google Scholar 

  19. The Japan Esophageal Society. Guidelines for diagnosis and treatments of esophageal cancer. 3rd ed. Tokyo: Kanehara Co. Ltd.; 2012 (Japanese)

  20. Basch E, Iasonos A, McDonough T, et al. Patient versus clinician symptom reporting using the National Cancer Institute Common Terminology Criteria for Adverse Events: results of a questionnaire-based study. Lancet Oncol. 2006;7:903–9.

    Article  Google Scholar 

  21. Dolan JP, Kaur T, Diggs BS, et al. Impact of comorbidity on outcomes and overall survival after open and minimally invasive esophagectomy for locally advanced esophageal cancer. Surg Endosc. 2013;27:4094–103.

    Article  Google Scholar 

  22. Anderson SE, Minsky BD, Bains M, et al. Combined modality chemoradiation in elderly oesophageal cancer patients. Br J Cancer. 2007;96:823–7.

    Google Scholar 

  23. Toya Y, Endo M, Nakamura S, et al. Long-term outcomes and prognostic factors with non-curative endoscopic submucosal dissection for gastric cancer in elderly patients aged ≥ 75 years. Gastric Cancer. 2018. https://doi.org/10.1007/s10120-018-00913-9.

    Article  PubMed  Google Scholar 

  24. Shimada H, Shiratori T, Okazumi S, et al. Surgical outcome of elderly patients 75 years of age and older with thoracic esophageal carcinoma. World J Surg. 2007;31:773–9.

    Article  Google Scholar 

  25. Schweigert M, Solymosi N, Dubecz A, et al. Current outcome of esophagectomy in the very elderly: experience of a German high-volume center. Am Surg. 2013;79:754–63.

    PubMed  Google Scholar 

  26. Lu X, Wu H, Wang J, et al. Short-and long-term outcomes of definitive chemoradiotherapy in patients with esophageal carcinoma aged ≥ 75 years. Mol Clin Oncol. 2014;2:297–301.

    Article  Google Scholar 

  27. Ishikura S, Nihei K, Ohtsu A, et al. Long-term toxicity after definitive chemoradiotherapy for squamous cell carcinoma of the thoracic esophagus. J Clin Oncol. 2003;21:2697–702.

    Article  CAS  Google Scholar 

  28. Townsley CA, Selby R, Siu LL. Systematic review of barriers to the recruitment of older patients with cancer onto clinical trials. J Clin Oncol. 2005;23:3112–244.

    Article  Google Scholar 

Download references

Acknowledgements

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan

    Keiichiro Nakajo & Tomonori Yano

  2. Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

    Seiichiro Abe & Ichiro Oda

  3. Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan

    Ryu Ishihara

  4. Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan

    Masaki Tanaka

  5. Department of Gastroenterology, Cancer Institute Hospital of JFCR, Tokyo, Japan

    Toshiyuki Yoshio

  6. Department of Gastroenterology, Kitasato University School of Medicine, Kanagawa, Japan

    Chikatoshi Katada

Authors
  1. Keiichiro Nakajo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seiichiro Abe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ichiro Oda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ryu Ishihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masaki Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Toshiyuki Yoshio
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Chikatoshi Katada
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tomonori Yano
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception and design: KN and TY; analysis and interpretation of the data: KN and TY; drafting of the article: KN and TY; critical revision of the article for important intellectual content: TY, SA, IO, RI, MT, TY, and CK; final approval of the article: KN, TY, SA, IO, RI, MT, TY, and CK.

Corresponding author

Correspondence to Tomonori Yano.

Ethics declarations

Conflict of interest

All the authors disclosed no financial relationships relevant to this publication.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nakajo, K., Abe, S., Oda, I. et al. Impact of the Charlson Comorbidity Index on the treatment strategy and survival in elderly patients after non-curative endoscopic submucosal dissection for esophageal squamous cell carcinoma: a multicenter retrospective study. J Gastroenterol 54, 871–880 (2019). https://doi.org/10.1007/s00535-019-01583-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00535-019-01583-9

Keywords

Search

Navigation