Abstract
Purpose
The purpose of this study was to explore which therapeutic strategy is more beneficial for elderly esophageal cancer (EC) patients with distant metastasis, the treatment utilization status and the screening of factors related to prognosis, so as to better guide the treatment of these patients.
Methods
Patients in the Surveillance Epidemiology and End Results (SEER) database were divided into chemoradiotherapy (Group A), chemotherapy (Group B), radiotherapy (Group C), and no treatment (Group D) according to different treatment methods. Propensity score matching (PSM) was performed to adjust for baseline differences between the two groups. Overall survival (OS) and esophageal cancer-specific survival (ECSS) was calculated using the Kaplan–Meier method and compared using the log-rank test.
Results
A total of 7027 patients were included in this study, 5739 males (81.7%) and 1288 females (18.3%) with the median age was 70 (60–98). In the original cohort, the number of patients in the four groups was 2260 (Group A), 2087 (Group B), 945 (Group C) and 1735 (Group D), respectively. After PSM, there was no significant difference in mean OS (A vs B, 13.5 months VS 13.4 months, P = 0.511) and mean ECSS (A vs B, 15.6 vs 15.5 months, P = 0.374), while both OS (B vs C, 7 vs 3 months, P < 0.001) and ECSS (B vs C, 8 vs 3 months, P < 0.001) of chemotherapy alone were significantly better than those of radiotherapy alone. Subgroup analysis of patients older than 80 years showed that the median OS (A vs B, 7 vs 6 months) and median ECSS (A vs B, 8 vs 7 months) of Group A were significantly better than those of Group B (P < 0.05). In addition, all patients were randomly divided into a training set and a validation set with a ratio of 7:3. Based on the independent risk factors for OS, a nomogram model was constructed and validated.
Conclusion
For elderly EC patients with distant metastasis, aggressive treatment was still necessary after a comprehensive assessment of the patient's physical condition, especially for patients over 80 years old, and chemoradiotherapy maybe still the first choice. In addition, a nomogram model was constructed to intuitively and accurately evaluate the prognosis of this population.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability statement
The data that support the findings of this study are available from the corresponding author, [LW], upon reasonable request.
References
Ajani JA, D’Amico TA, Bentrem DJ, Chao J, Corvera C, Das P, Denlinger CS et al (2019) Esophageal and esophagogastric junction cancers, version 2.2019, NCCN clinical practice guidelines in oncology [in Eng]. J Natl Compr Canc Netw 17(7):855–883. https://doi.org/10.6004/jnccn.2019.0033
Chen F, Luo H, Xing L, Liang N, Xie J, Zhang J (2018) Feasibility and efficiency of concurrent chemoradiotherapy with capecitabine and cisplatin versus radiotherapy alone for elderly patients with locally advanced esophageal squamous cell carcinoma: experience of two centers [in Eng]. Thorac Cancer 9(1):59–65. https://doi.org/10.1111/1759-7714.12536
Chen Y, Cheng X, Song H, Wu AJ, Ku GY, Lee P, Slingerland M et al (2019) Outcomes of concurrent chemoradiotherapy versus chemotherapy alone for esophageal squamous cell cancer patients presenting with oligometastases [in Eng]. J Thorac Dis 11(4):1536–1545. https://doi.org/10.21037/jtd.2019.03.10
Deana C, Vetrugno L, Bignami E, Bassi F (2021) Peri-operative approach to esophagectomy: a narrative review from the anesthesiological standpoint [in Eng]. J Thorac Dis 13(10):6037–6051. https://doi.org/10.21037/jtd-21-940
Elimova E, Mizrak Kaya D, Harada K, Ajani JA (2016) Potentially curable cancers of the esophagus and stomach [in Eng]. Mayo Clin Proc 91(9):1307–1318. https://doi.org/10.1016/j.mayocp.2016.07.018
Erkizan HV, Sukhadia S, Natarajan TG, Marino G, Notario V, Lichy JH, Wadleigh RG (2021) Exome sequencing identifies novel somatic variants in african american esophageal squamous cell carcinoma [in Eng]. Sci Rep 11(1):14814. https://doi.org/10.1038/s41598-021-94064-0
Guttmann DM, Mitra N, Bekelman J, Metz JM, Plastaras J, Feng W, Swisher-McClure S (2017) Improved overall survival with aggressive primary tumor radiotherapy for patients with metastatic esophageal cancer [in Eng]. J Thorac Oncol 12(7):1131–1142. https://doi.org/10.1016/j.jtho.2017.03.026
Hong L, Huang YX, Zhuang QY, Zhang XQ, Tang LR, Du KX, Lin XY et al (2018) Survival benefit of re-irradiation in esophageal cancer patients with locoregional recurrence: a propensity score-matched analysis [in Eng]. Radiat Oncol 13(1):171. https://doi.org/10.1186/s13014-018-1122-y
Jain R, Yee JL, Shaikh T, Au C, Handorf E, Meyer JE, Dotan E (2020) Treatment-related toxicity and outcomes in older versus younger patients with esophageal cancer treated with neoadjuvant chemoradiation [in Eng]. J Geriatr Oncol 11(4):668–674. https://doi.org/10.1016/j.jgo.2019.06.014
Kitagawa Y, Uno T, Oyama T, Kato K, Kato H, Kawakubo H, Kawamura O et al (2019) Esophageal cancer practice guidelines 2017 edited by the Japan Esophageal Society: part 1 [in Eng]. Esophagus 16(1):1–24. https://doi.org/10.1007/s10388-018-0641-9
Kuwano H, Nishimura Y, Oyama T, Kato H, Kitagawa Y, Kusano M, Shimada H et al (2015) Guidelines for diagnosis and treatment of carcinoma of the esophagus April 2012 edited by the Japan Esophageal Society [in Eng]. Esophagus 12(1):1–30. https://doi.org/10.1007/s10388-014-0465-1
Liang H, Peng H, Chen L (2021) Prognostic value of sarcopenia and systemic inflammation markers in patients undergoing definitive radiotherapy for esophageal cancer [in Eng]. Cancer Manag Res 13:181–192. https://doi.org/10.2147/cmar.S288522
Ma Z-H, Yang Y, Zou L, Luo K-Y (2012) 125i seed irradiation induces up-regulation of the genes associated with apoptosis and cell cycle arrest and inhibits growth of gastric Cancer xenografts [in Eng]. J Exp Clin Cancer Res CR 31(1):61. https://doi.org/10.1186/1756-9966-31-61
Nagata Y, Yamamoto S, Kato K (2022) Immune checkpoint inhibitors in esophageal cancer: clinical development and perspectives [in Eng]. Hum Vaccin Immunother 18(6):2143177. https://doi.org/10.1080/21645515.2022.2143177
Ogawa H, Yajima T, Sohda M, Shirabe K, Saeki H (2021) Role of surgical resection and its alternative local therapy for pulmonary metastasis of colorectal cancer [in Eng]. Ann Gastroenterol Surg 5(6):747–753. https://doi.org/10.1002/ags3.12472
Qie S, Shi H, Wang F, Liu F, Gu J, Liu X, Li Y, Sun X (2022) Construction of survival prediction model for elderly esophageal cancer [in Eng]. Front Oncol 12:1008326. https://doi.org/10.3389/fonc.2022.1008326
Shirai K, Tamaki Y, Kitamoto Y, Murata K, Satoh Y, Higuchi K, Ishikawa H et al (2013) Prognosis was not deteriorated by multiple primary cancers in esophageal cancer patients treated by radiotherapy [in Eng]. J Radiat Res 54(4):706–711. https://doi.org/10.1093/jrr/rrt002
Siegel RL, Miller KD, Wagle NS, Jemal A (2023) Cancer statistics, 2023 [in Eng]. CA Cancer J Clin 73(1):17–48. https://doi.org/10.3322/caac.21763
Smyth EC, Lagergren J, Fitzgerald RC, Lordick F, Shah MA, Lagergren P, Cunningham D (2017) Oesophageal cancer [in Eng]. Nat Rev Dis Primers 3:17048. https://doi.org/10.1038/nrdp.2017.48
Suárez-Lledó A, Leiva-Badosa E, Llop-Talaveron JM, Fernández-Alvarez M, Farran-Teixidor L, Miró-Martín M, Virgili-Casas N et al (2021) Clinical, randomized, double blind clinical trial to study the effect of parenteral supplementation with fish oil emulsion in the nutritional support in esophagectomized patients [in Eng]. Medicine (baltimore) 100(25):e26426. https://doi.org/10.1097/md.0000000000026426
Wu Y, Hu L, Liang Y, Li J, Wang K, Chen X, Meng H et al (2017) Up-regulation of Lncrna Casc9 promotes esophageal squamous cell carcinoma growth by negatively regulating Pdcd4 expression through Ezh2" [in Eng]. Mol Cancer 16(1):150. https://doi.org/10.1186/s12943-017-0715-7
Wu Y, Chen J, Zhao L, Li Q, Zhu J, Yang H, Guo S, Xi M (2021) Prediction of pathologic response to neoadjuvant chemoradiotherapy in patients with esophageal squamous cell carcinoma incorporating hematological biomarkers [in Eng]. Cancer Res Treat 53(1):172–183. https://doi.org/10.4143/crt.2020.594
Zhai H, Huang Y, Li L, Zhang X, Yao J (2020) Mortality from heart disease following radiotherapy in esophageal carcinoma: a retrospective cohort study in US Seer Cancer Registry [in Eng]. Transl Cancer Res 9(4):2556–2564. https://doi.org/10.21037/tcr.2020.03.21
Zhang R, Jia M, Li P, Han J, Huang K, Li Q, Qiao Y et al (2019) Radiotherapy improves the survival of patients with metastatic esophageal squamous cell carcinoma: a propensity score matched analysis of surveillance, epidemiology, and end results database [in Eng]. Dis Esophagus. https://doi.org/10.1093/dote/doy074
Zhao Q, Hu G, Xiao W, Chen Y, Shen M, Tang Q, Ning X (2017) Comparison of definitive chemoradiotherapy and radiotherapy alone in patients older than 75 years with locally advanced esophageal carcinoma: a retrospective cohort study [in Eng]. Medicine (baltimore) 96(35):e7920. https://doi.org/10.1097/md.0000000000007920
Zhou S, Yang Y, Zhang Q, Zhu C, Cai P, Li D (2023) Analysis of the prognostic factors of simultaneous integrated boost-intensity modulated radiation therapy (Sib-Imrt) in 220 cases of locally advanced squamous esophageal cancer: a retrospective cohort study [in Eng]. Ann Transl Med 11(2):103. https://doi.org/10.21037/atm-22-6462
Funding
None.
Author information
Authors and Affiliations
Contributions
L-QH designed research; L-QH conducted research; L-QH, T-TC and X-NJ analyzed data; L-QH wrote the paper; L-QH, WL had primary responsibility for final content. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
All authors disclosed no conflicts of interest.
Ethics approval
As the dataset included in our research was obtained from a public database, the study did not require the approval of an ethics committee.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Han, LQ., Cui, TT., Xiao, NJ. et al. Prognostic analysis and treatment utilization of different treatment strategies in elderly esophageal cancer patients with distant metastases: a SEER database analysis. J Cancer Res Clin Oncol 149, 15413–15423 (2023). https://doi.org/10.1007/s00432-023-05260-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00432-023-05260-6