Treatment patterns and Outcomes of Elderly Patients with Potentially Curable Esophageal Cancer

Abstract Background: The proportion of elderly patients with esophageal cancer (EC) is increasing due to prolonged life expectancy and aging process. However, the optimal treatment strategy for elderly patients (aged ≥70 years) with EC remains controversial. Methods: Eligible patients with cT1b-4aNxM0 EC were identified in the Surveillance, Epidemiology, and End Results database from 2010 to 2016. Treatment patterns were divided into five groups: surgical resection (S), chemoradiotherapy (CRT), radiotherapy (RT), chemotherapy (CT), or observation with no treatment (Obs). Survival between groups was compared using the log-rank test, and the Cox proportional hazards model was used to identify factors associated with overall survival (OS). Results: A total of 3233 patients with potentially curable EC were identified. Of all the patients included, 29.1%, 48.2%, 8.7%, and 3.5% received S, CRT, RT, and CT, respectively, whereas 10.5% underwent Obs. The 3-year OS estimates were 45.8% (95% confidence interval [CI]: 42.2–49.8%), 26.1% (95% CI: 23.5–28.9%), 12.2% (95% CI: 8.4–17.8%), 14.9% (95% CI: 8.4–26.4%), and 6.7% (95% CI: 4.0–11.0%) for S, CRT, RT, CT, and Obs (p<0.001), respectively. However, the survival benefits of surgery over CRT gradually weakened with the increase in age, and the survival benefit of surgery was statistically non-significant for EC patients aged ≥80 years (p=0.41). Multivariate analysis showed that treatment patterns, age, tumor grade, T stage, N stage, and marital status were significantly associated with OS. Conclusion: Generally, the use of surgery was associated with the longest OS, and CRT was superior to RT or CT alone in elderly patients with curable EC. For patients intolerable to surgery or aged ≥80 years, definitive CRT should be considered as a preferable option. The optimal treatment strategy for elderly patients with EC should consider comprehensive geriatric assessment, survival benefit, and patient preference in a multidisciplinary setting.