Does Esophagectomy Provide a Survival Advantage to Patients Aged 80 Years or Older? Analyzing 5,066 Patients in the National Database of Hospital-Based Cancer Registries in Japan.

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To determine whether esophagectomy provides a survival advantage in octogenarians with resectable thoracic esophageal cancer.Elderly patients with thoracic esophageal cancer do not always receive the full standard treatment; however, advanced age alone should not preclude the use of effective treatment that could meaningfully improve survival.We retrieved the 2008-2011 data from the National Database of Hospital-based Cancer Registries from the National Cancer Center in Japan, divided the patients into a ≥75 group (75-79 years; n = 2,935) and a ≥80 group (80 years or older; n = 2,131), and then compared the patient backgrounds and survival curves. A multivariable Cox proportional hazards regression model was developed to compare the effects of esophagectomy and chemoradiotherapy in the two groups.A significantly greater percentage of patients were treated with esophagectomy in the ≥75 group (34.6%) than the ≥80 group (18.4%). Among patients who received esophagectomy, the 3-year survival rate was 51.1% in the ≥75 group and 39.0% in the ≥80 group (P < 0.001). However, among patients who received chemoradiotherapy, there was no difference in survival curve between the two groups (P = 0.17). Multivariable Cox proportional hazard analysis revealed that esophagectomy for clinical Stage II-III patients was significantly associated to better survival (adjusted HR: 0.731) (95%CI: 0.645-0.829, p < 0.001) in the ≥75 group but not the ≥80 group when compared with CRT.Many octogenarians do not necessarily get a survival benefit from esophagectomy. However, patients should be evaluated based on their overall health before ruling out surgery based on age alone.

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Authors: Satoru Motoyama, Eri Maeda, Katsunori Iijima, Yusuke Sato, Shigeto Koizumi, Akiyuki Wakita, Yushi Nagaki, Hiromu Fujita, Takatoshi Yoneya, Kazuhiro Imai, Kaori Terata, Yoshihiro Minamiya, Takahiro Higashi