Comparative Analysis Of The Prognosis Of RT And CRT In Elderly Patients With Early Esophageal Cancer

Background and purposeIn China,esophageal cancer(esophageal cancer,EC)is a common malignant tumor of digestive system and the incidence of EC ranks first in the world.With the development of endoscopic technology,the diagnosis rate of early EC is increasing.Radical resection and endoscopic therapy are the main treatment methods for these patients.However,due to the large surgical trauma and many postoperative complications,some people refuse surgery and choose conservative treatment.Compared with young patients,elderly patients have poor physiological reserve function,more underlying diseases,more perioperative mortality and postoperative complications,and significantly reduced quality of life caused by surgery.Therefore,age has become a relative contraindication for early esophageal cancer patients.Early EC is considered to be a local lesion.Radiotherapy is the first choice for patients who refuse or cannot tolerate surgery.Chemotherapy,as a systemic therapy,will benefit remains to be further verified.Compared with the young patients,the organ physiological function and tolerance are decreased,chemotherapy drugs can increase the toxicity of these elderly patients.For now,no conclusive evidence that in patients with early esophageal cancer indicated that chemoradiotherapy is better than radiotherapy alone.The purpose of this study was to compare the prognosis of patients with early EC aged 80 years or older with radiotherapy alone and chemoradiotherapy,so as to provide reference for clinical treatment.Objects and MethodsClinical data of esophageal cancer patients aged 80+in SEER database were retrospectively analyzed.The screened patients were used as a total sample to analyze the overall survival rate(OS)of the patients,excluding survival or death from other causes,and the end event was death from esophageal cancer.This data was used to analyze the tumor specific survival rate(CSS)of the patients.Methods:SPSS 25.0 was used for analysis.We used COX proportional risk model to analyze the independent prognostic factors of patients.95%confidence interval and risk ratio were used for regression analysis.We used K-M curve and log-rank test to analyze and compare the OS and CSS of patients in different subgroups and different treatment methods.Test level α=0.05.To verify the accuracy of the results,we obtained clinical studies from public databases for comparative discussion.ResultsDatabase is a collection of 828 elderly in patients with esophageal cancer.We analyzed the clinical pathological data of this part of the patients.The results showed that,in terms of the choice of treatment mode,most patients chose to add chemotherapy as the treatment mode.Multivariate COX analysis showed that gender,tumor location,pathological grade,T stage,N stage and treatment mode were independent and significant prognostic factors of OS(P<0.05),while race,clinical stage and non-operative reasons had no significant effect on prognosis(P>0.05).Time of diagnosis and pathological type were prognostic risk factors of CSS.In the total sample,there was a significant difference in the OS between radiotherapy alone and chemoradiotherapy.After analysis of each subgroup,the results showed that,whether in the total sample or each subgroup,patients receiving synchronous or sequential chemotherapy had a significant difference in prognosis and survival compared with radiotherapy alone.Finally,we screened a total of 5 clinical studies on patients aged 80+to compare the prognosis with our conclusions.ConclusionThe addition of chemotherapy in radiotherapy resulted in better OS in elderly patients with early-stage non-surgical esophageal cancer,from which patients could benefit significantly.Most patients still choose to add chemotherapy.Gender,tumor location as the choice of treatment mode.Pathological grade,T stage and N stage were the risk factors for OS,while time of diagnosis and pathological type were the prognostic risk factors for CSS.In the subgroup analysis of various risk factors,the addition of chemotherapy would bring a better prognosis.Existing research data suggest that the addition of chemotherapy can bring a good prognosis for patients with early ultra-elderly esophageal cancer,but it is still controversial.