ASO Author Reflections: The Impact of Preoperative Chemotherapy on Survival After Esophagectomy in Elderly Patients with
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: The Impact of Preoperative Chemotherapy on Survival After Esophagectomy in Elderly Patients with Esophageal Cancer Eisuke Booka, MD, PhD1, Ryoma Haneda, MD1,2, Kenjiro Ishii, MD, PhD1, and Yasuhiro Tsubosa, MD, PhD1 1
Division of Esophageal Surgery, Shizuoka Cancer Center Hospital, Sunto-gun, Shizuoka , Japan; 2Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka , Japan
PAST Based on the results of the JCOG9907 trial, the 2017 Esophageal Cancer Practice Guidelines, edited by the Japan Esophageal Society, strongly recommend preoperative chemotherapy in patients with cStage II or III esophageal cancer;1,2 however, this recommendation is restricted to patients aged 75 years or younger because JCOG9907 did not include patients aged over 75 years. The impact of preoperative chemotherapy on postesophagectomy survival rates in elderly patients with esophageal cancer remains unclear, making the standard treatment for elderly patients with esophageal cancer controversial. PRESENT In our article published in Annals of Surgical Oncology, we analyzed 42 patients with cStage II or III esophageal cancer aged between 75 and 80 years.3 Eighteen patients underwent esophagectomy without preoperative chemotherapy, while 24 underwent esophagectomy after preoperative chemotherapy. On multivariate analysis, preoperative chemotherapy (hazard ratio 5.025, 95% confidence interval 1.136–22.222; p = 0.033) was found to be an independent negative prognostic factor for overall survival (OS). Subgroup analysis showed that preoperative
Ó Society of Surgical Oncology 2020 First Received: 14 August 2020 Accepted: 18 August 2020 Y. Tsubosa, MD, PhD e-mail: [email protected]
chemotherapy was not only ineffective for patients with a performance status (PS) of 0 but also had a significantly negative impact on OS in patients with a PS of 1 (p \ 0.001). In this study, the 5-year OS was 42.8% in the 12 patients with a PS of 1 who underwent esophagectomy without preoperative chemotherapy, comparable with the OS of patients aged B 75 years in JCOG9907 who did not receive preoperative chemotherapy.1,3 FUTURE The number of elderly patients with esophageal cancer is on the rise as the population ages.4 For tailored medicine, younger patients with cStage II or III esophageal cancer should receive preoperative chemotherapy followed by esophagectomy. Conversely, elderly patients, especially vulnerable patients, should not receive preoperative chemotherapy because they usually have a good prognosis with esophagectomy alone. We recommend an external validation study involving a sufficient sample size to confirm our findings. DISCLOSURES Eisuke Booka, Ryoma Haneda, Kenjiro Ishii, and Yasuhiro Tsubosa declare they have no conflicts of interest or funding to report in relation to this study.
REFERENCES 1. Ando N, Kato H, Igaki H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized ad
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