The Negative Impact of Preoperative Chemotherapy on Survival After Esophagectomy for Vulnerable Elderly Patients with Es
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ORIGINAL ARTICLE – THORACIC ONCOLOGY
The Negative Impact of Preoperative Chemotherapy on Survival After Esophagectomy for Vulnerable Elderly Patients with Esophageal Cancer Eisuke Booka, MD, PhD1, Ryoma Haneda, MD1,2, Kenjiro Ishii, MD, PhD1, Takahiro Tsushima, MD3, Hirofumi Yasui, MD3, and Yasuhiro Tsubosa, MD, PhD1 1
Division of Esophageal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan; 2Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan; 3Division of Gastrointestinal Oncology, Shizuoka Cancer Center Hospital, Shizuoka, Japan
ABSTRACT Background. The standard treatment for patients 75 years of age or younger with cStage 2 or 3 esophageal cancer is preoperative chemotherapy followed by esophagectomy. The optimal treatment for elderly patients, especially those considered vulnerable, remains unclear. Methods. This study retrospectively reviewed the data for 42 patients ages 75–80 years with cStage 2 or 3 esophageal cancer who underwent esophagectomy between October 2002 and February 2019. The patients who received preoperative chemotherapy were compared with those who did not. The study also examined short- and long-term outcomes and the impact of preoperative chemotherapy on overall survival (OS) stratified by performance status (PS). Results. Of the 42 patients, 18 underwent esophagectomy without preoperative chemotherapy and 24 underwent esophagectomy after preoperative chemotherapy. A significantly greater proportion of the patients with PS 0 received preoperative chemotherapy than the patients with PS 1 (P =0.007). The multivariate analysis showed preoperative chemotherapy to be an independent negative prognostic factor for OS (hazard ratio [HR], 5.025; 95% confidence interval [CI] 1.136–22.222; P = 0.033). Subgroup analysis showed that preoperative chemotherapy had
Ó Society of Surgical Oncology 2020 First Received: 25 June 2020 Accepted: 9 August 2020 Y. Tsubosa, MD, PhD e-mail: [email protected]
a significant negative impact on the OS of the patients with PS 1 (P \ 0.001). Conclusion. Preoperative chemotherapy was ineffective for the patients with PS 0 and had a significantly negative impact on the OS of the patients with PS 1. Preoperative chemotherapy should not be administered to patients 75 years of age or older with cStage 2 or 3 esophageal cancer.
Esophageal cancer is the sixth leading cause of cancerrelated mortality worldwide because of its high malignant potential and poor prognosis.1 The postoperative 5-year survival rate for patients with American Joint Committee on Cancer (AJCC) stage 1 esophageal cancer is approximately 90%. This rate decreases to 45% for patients with stage 2 disease, 20% for patients with stage 3 disease, and 10% for patients with stage 4 disease.2 A randomized controlled trial (RCT) by the Japan Clinical Oncology Group (JCOG9907) comparing pre- and postoperative chemotherapy with cisplatin and fluorouracil showed superior overall survival (OS) for the preoperative chemotherapy group.3 The 2017 Esophageal Cancer Practice Guidelin
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