Prognostic Value Of Different Treatment Methods In Elderly Patients With Esophageal Squamous Cell Carcinoma

Purpose: This study aims to analyze the prognosis and influencing factors of different treatments methods in elderly patients with esophageal squamous cell carcinoma(ESCC),and provide references for the treatment of elderly patients with ESCC.Method: A total of 529 elderly patients with ESCC aged 70 years or older who underwent radical treatment in Shandong Provincial Cancer Hospital from January 2003 to December 2013 were retrospetively analyzed,72 of whom were lost to follow-up.According to different treatment methods,457 patients were divided into two groups.The operation group(n=90)included surgery alone or combined with postoperative adjuvant radiotherapy and postoperative adjuvant chemotherapy.The radiotherapy group(n=367)included radiotherapy alone,concurrent chemoradiotherapy or sequential chemoradiotherapy.The patient's clinical characteristics,tumor stage and toxic side effects were collected,and the disease progression time and death time were obtained by telephone follow-up,etc.A total of253 patients were enrolled in the study after pairing with propensity score matching(PSM).Chi-square test was used to analyze differences between groups.Kaplan-Meier analysis was used to calculate survival times,the Log-Rank test for univariate analysis,and Cox model multivariate analysis to identify indenpendent prognostic factors.Result: The follow-up ends in May 2018,72 patients were lost to follow-up,and the follow-up rate was 86.4%.The 1-,3-,and 5-years of progression-free survival(PFS)and overall survival(OS)were 62.5%,37.0%,30.8%,and 77.5%,44.2%,and 33.9%,respectively.The median OS was 29 months(95% CI 23.337-34.663)and the median PFS was 20 months(95% CI 15.604-24.396).Univariate analysis indicated that lesion length,N-stage,TNM-stage,ECOG score and efficacy evaluation affected OS;The independent prognostic factors for better OS were N-stage,ECOG score,and efficacy evaluation.The OS and PFS between the surgical and radiotherapy groups after matching had no significant difference(P=0.268,P=0.651).The OS and PFS between the different treatment subgroups in the surgical group and the radiotherapy group had no significant difference.The OS and PFS between the different treatment subgroups with different radiation doses had no significant difference.Patients receiving ?3 cycles of chemotherapy had better OS and PFS than patients receiving1-2 cycles of chemotherapy(P=0.038,P=0.016).A total of 191(75.49%)patients in the matched group had treatment failure,including 159 cases(62.85%)with partial failure,15cases(5.93%)with distant metastasis,and 17 cases(6.72%)with local failure and distant metastasis.The failure patterns between the surgery and radiotherapy groups had no significant difference.All patients were treated,and the related side effects were mainly 1-2grade acute radiation esophagitis(46.24%),acute radiation pneumonitis(8.30%),acute gastrointestinal reactions(20.16%)and myelosuppression.Acute toxic side effects of grade?3 are rare.Conclusion: For elderly patients with esophageal cancer,it is safe and effective to receive radiotherapy-based or surgery-based comprehensive treatment,and can achieve similar results as non-elderly patients.Patients with radiation or surgery who receive more than 3 cycles of chemotherapy may improve patient survival,as long as physical conditions permit.