Analysis Of The Clinical Characteristics And The Prognosis Of Elderly Patients(≥70 Years)with Esophageal Cancer

Purpose:To analyze the clinical characteristics and the prognosis of elderly patients(≥70 years old)with esophageal cancer,especially patients who are 80 years and older.To evaluate the treatment strategies of elderly patients with esophageal cancer in the age of population aging.Methods:The national Surveillance,Epidemiology,and End Results database was analyzed retrospectively for the elderly esophageal cancer patients(>70 years old).We divided 15,612 patients with esophageal cancer between 2004 and 2012 into three age groups(younger than 70 years,70 to 79 years,and 80 years and older).A comparison was carried out between patients in different age groups for demographics and stage distribution,and analyzed the differences among the groups in treatment strategy(no treatment,radiotherapy only,surgery only,and surgery combined with radiotherapy)and long-term outcome after treatment.In addition,patients who suffered locoregional esophageal cancer(TNM Ⅰ Ⅱ and Ⅲ)had been studied and discussed in the same manner.Results:Among 15,612 patients qualified for the study,1,857 patients were 80 years and older which takes account 11.9 percent(i.e.,very elderly);3,596 patients were 70-79 years old which takes account 23.0 percent;and 10,159 patients were smaller than 70 years old which takes account 65.1 percent.The distribution by means of stage and histology was comparable for all the three groups.The 5-year cancer-specific survival was lower in the elderly,and even worse was for the very elderly patients(≥80 years old,70-79 years old,<70 years old:5.4%,14.6%,20.1%;P<0.001)across marital state,gender,TNM phases,ethnic varieties and histologic grade.Patients who are 70 years and older were less possible to accept regional treatment(radiotherapy as well as surgery)than patients who were younger(26.9%vs 28.4%vs 40.4%for the age subgroups>80 years old,70 to 79 years old,and<70 years old separately).Age,race,marital status,histological grade,histological type,and TNM stage were independent and significant prognostic factors in patients with esophageal cancer.On the whole,the results of patients with esophageal cancer were becoming worse accompanying with age.The total survival ratio was much lower among patients of the group 70 to 79 years old and group ≥80 years old compared with group<70 years old(p<0.001).However,aggressive treatment,especially surgical treatment,can significantly improve the prognosis of elderly patients(≥70 years old).The 5-year cancer-specific survival after surgery of them was relatively high even when it came to the patients whose age was or older than 80 years old.The statistical distribution of patients who suffered locoregional esophageal cancer was similar to that of entire patientsConclusion:Patients aged 70 years and older occupy 34.9 percent(≥80 years old occupy I1.9 percent)of the total number of esophageal cancer patients studied.Elderly patients(≥70 years old),especially the very elderly patients(≥80 years old),are less likely to receive surgery or radiotherapy than younger patients.Moreover,when compared with patients who are younger than them,they have worse results partly because of physical status and psychosocial factors.Having considered the total physical status elaborately,it is reasonable to adopt aggressive therapy,particularly surgical therapy,for elderly patients.