Hu LL, Rong F, Liu L, Zhang L, Zhang LL, Yang Q, Xia ZL, Wang H. Prognosis of radiotherapy for esophageal cancer in elderly patients exceeding seventy-five years old. World J Gastrointest Oncol 2024; 16(12): 4636-4649 [DOI: 10.4251/wjgo.v16.i12.4636]
Corresponding Author of This Article
Hui Wang, MD, PhD, Doctor, Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei Economic Development Zone, Hefei 230601, Anhui Province, China. 1223556508@qq.com
Research Domain of This Article
Oncology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Dec 15, 2024; 16(12): 4636-4649 Published online Dec 15, 2024. doi: 10.4251/wjgo.v16.i12.4636
Prognosis of radiotherapy for esophageal cancer in elderly patients exceeding seventy-five years old
Li-Li Hu, Feng Rong, Lei Liu, Ling Zhang, Lei-Lei Zhang, Qun Yang, Zhao-Long Xia, Hui Wang
Li-Li Hu, Feng Rong, Ling Zhang, Lei-Lei Zhang, Qun Yang, Zhao-Long Xia, Department of Cancer Center, Lu’an Hospital of Anhui Medical University, Lu’an 237002, Anhui Province, China
Lei Liu, College of Health and Elderly Care, Anhui Vocational College of City Management, Hefei 230012, Anhui Province, China
Hui Wang, Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
Author contributions: Hu LL and Wang H conceived and designed the study and performed the data analysis and interpretation, as well as the initial drafting of the manuscript; Zhang L, Yang Q and Xia ZL helped collect the data; and Rong F, Liu L, and Zhang LL provided critical revisions to the manuscript; All authors reviewed the results and approved the final version of the manuscript.
Supported bythe Science and Technology Program of Lu’an, No. 2022 Lakj042.
Institutional review board statement: This study was approved by the Ethics Committee of Lu’an Hospital of Anhui Medical University, No. 2023 LLKS035.
Informed consent statement: In this study, informed consent was obtained from the patients and their families.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The datasets generated and/or analyzed in the current study can be obtained from the corresponding author upon a reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hui Wang, MD, PhD, Doctor, Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei Economic Development Zone, Hefei 230601, Anhui Province, China. 1223556508@qq.com
Received: May 30, 2024 Revised: September 22, 2024 Accepted: October 8, 2024 Published online: December 15, 2024 Processing time: 165 Days and 22.9 Hours
Abstract
BACKGROUND
Esophageal cancer (EC) often occurs in the elderly, with approximately 33% of patients aged ≥ 75 years at the time of diagnosis.
AIM
To evaluate the prognostic factors for radiotherapy (RT) in elderly patients with unresectable EC.
METHODS
We retrospectively analyzed the clinical characteristics, toxic reactions, and survival information of EC patients aged ≥ 75 years who underwent intensity-modulated RT at Lu’an Hospital of Anhui Medical University between January 2016 and September 2023. Kaplan-Meier analysis was used to draw the overall survival (OS) curves, and Cox regression analysis was employed to evaluate the influence of various clinical factors on the prognosis.
RESULTS
A total of 139 patients were enrolled. The median follow-up time was 52.0 months. The median OS was 20.0 months. The 1-year, 2-year, 3-year, and 5-year OS rates were 69.8%, 38.7%, 28.2%, and 17.5%, respectively. Univariate analysis showed that age, radiation dose, and chemotherapy had no significant impact on prognosis. Multivariate analysis indicated that clinical stage [III-IVa vs I-II, hazard ratio (HR) = 2.421, 95% confidence interval (CI): 1.242-4.718, P = 0.009; IVb vs I-II, HR = 4.222, 95%CI: 1.888-9.438, P < 0.001), Charlson comorbidity index (CCI) (0 vs ≥ 1, HR = 1.539, 95%CI: 1.015-2.332, P = 0.042), and nutritional risk screening 2002 (NRS2002) (< 3 vs ≥ 3, HR = 2.491, 95%CI: 1.601-3.875, P < 0.001) were independent prognostic factors for OS.
CONCLUSION
Our results suggest that CCI and NRS2002 were independent prognostic factors of OS for unresectable elderly EC patients undergoing RT. For elderly patients with EC, full attention should be given to biological age-related indicators, such as comorbidities and nutrition, when formulating treatment protocols. These factors should be considered in future clinical practice.
Core Tip: Esophageal cancer (EC) often occurs in the elderly, with approximately 33% of patients aged ≥ 75 years at the time of diagnosis. Since patients aged 75 years and above are often excluded from many clinical trials of EC, there is a lack of agreement regarding the prognosis and treatment of this population. We retrospectively analyzed the clinical characteristics, toxic reactions, and survival information of elderly patients with EC aged ≥ 75 years who received intensity-modulated radiotherapy. Our analysis aimed to evaluate the prognostic factors affecting overall survival. We found that the Charlson comorbidity index and nutritional risk screening 2002 were independent prognostic factors for overall survival. Our results suggest that when formulating treatment plans for elderly patients with EC, full attention should be given to age-related biological indicators such as comorbidities and nutrition.
