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Increased Resection Rates and Survival Among Patients Aged 75 Years and Older with Esophageal Cancer: A Dutch Nationwide Population-Based Study

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Abstract

Background

The incidence of esophageal cancer has grown over the recent decades and 30 % of esophageal cancer patients are now 75 years or older at the time of diagnosis. The aim of this study was to evaluate trends in management and survival of patients aged 75 years or older with esophageal cancer.

Methods

In the Netherlands cancer registry, we identified all patients aged 75 years or older who were diagnosed with esophageal cancer between 1989 and 2008. Trends in management and survival were analyzed by time period (1989–2001 vs. 2002–2008), TNM stage, and age (75–79, 80–84, and 85+ years). χ2 testing was used to analyze time trends in treatment, Kaplan–Meier analysis and log-rank testing to estimate survival, and Cox regression model to calculate hazard ratios for death.

Results

Some 7,253 patients were included in the study. The surgical resection rate increased over the 1989–2008 period from 8.9 to 12.6 % (p = 0.028), especially among patients aged 75–79 years (44.6 vs. 55.4 %, p < 0.001) and patients with TNM stage I disease (12.7 vs. 22.0 %, p < 0.001). The use of definitive chemoradiotherapy (CRT) also increased (0.19 vs. 2.20 %, p < 0.001). Whereas the use of chemotherapy as a single-modality treatment more than doubled (0.64 vs. 1.54 %, p = 0.004), that of radiotherapy alone decreased (38.1 vs. 31.6 %, p < 0.001). Although median survival time was marginally higher in the 2002–2008 period than in 1989–2001, overall 5 year survival rates remained low at 6 and 5 %, respectively (p < 0.001). Five-year survival rate after surgery increased from 16 to 30 % (p < 0.001).

Conclusions

In patients of 75 years or older, surgical treatment and use of definitive CRT have increased between 1989 and 2008. Also, an increase in the use of chemotherapy as a single modality was noted. Overall 5 year survival for all cancer patients was stable but remained poor, while survival of patients who underwent esophagectomy improved significantly in the Netherlands since 1989.

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Acknowledgments

This research was performed within the framework of the project “Progress against cancer in the Netherlands since the 1970s?” (Dutch Cancer Society grant 715401).

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Authors and Affiliations

  1. Department of Surgery, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands

    Zohra Faiz, Jan Willem W. Coebergh & Bas P. L. Wijnhoven

  2. Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven, The Netherlands

    Valery E. P. P. Lemmens & Jan Willem W. Coebergh

  3. Department of Public Health, Erasmus MC, Rotterdam, The Netherlands

    Valery E. P. P. Lemmens

  4. Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands

    Peter D. Siersema

  5. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands

    Grard A. P. Nieuwenhuijzen

  6. Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands

    Michel W. J. M. Wouters

  7. Department of Radiotherapy, Verbeeten Institute, Tilburg, The Netherlands

    Tom Rozema

Authors
  1. Zohra Faiz
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  2. Valery E. P. P. Lemmens
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  3. Peter D. Siersema
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  4. Grard A. P. Nieuwenhuijzen
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  5. Michel W. J. M. Wouters
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  7. Jan Willem W. Coebergh
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  8. Bas P. L. Wijnhoven
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Corresponding author

Correspondence to Bas P. L. Wijnhoven.

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Faiz, Z., Lemmens, V.E.P.P., Siersema, P.D. et al. Increased Resection Rates and Survival Among Patients Aged 75 Years and Older with Esophageal Cancer: A Dutch Nationwide Population-Based Study. World J Surg 36, 2872–2878 (2012). https://doi.org/10.1007/s00268-012-1762-2

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  • DOI: https://doi.org/10.1007/s00268-012-1762-2

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