Impact of Age and Comorbidity on Choice and Outcome of Two Different Treatment Options for Patients with Potentially Curable Esophageal Cancer

Z Faiz; M van Putten; R H A Verhoeven; J W van Sandick; G A P Nieuwenhuijzen; M J C van der Sangen; V E P P Lemmens; B P L Wijnhoven; J T M Plukker

doi:10.1245/s10434-019-07181-6

Impact of Age and Comorbidity on Choice and Outcome of Two Different Treatment Options for Patients with Potentially Curable Esophageal Cancer

Z Faiz, M van Putten, R H A Verhoeven, J W van Sandick, G A P Nieuwenhuijzen, M J C van der Sangen, V E P P Lemmens, B P L Wijnhoven, J T M Plukker

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Abstract

PURPOSE: This study was designed to assess the impact of age and comorbidity on choice and outcome of definitive chemoradiotherapy (dCRT) or neoadjuvant chemoradiotherapy plus surgery.

METHODS: In this population-based study, all patients with potentially curable EC (cT1N+/cT2-3, TX, any cN, cM0) diagnosed in the South East of the Netherlands between 2004 and 2014 were included. Kaplan-Meier method with log-rank tests and multivariable Cox regression analysis were used to compare overall survival (OS).

RESULTS: A total of 702 patients was included. Age ≥ 75 years and multiple comorbidities were associated with a higher probability for dCRT (odds ratio [OR] 8.58; 95% confidence interval [CI] 4.72-15.58; and OR 3.09; 95% CI 1.93-4.93). The strongest associations were found for the combination of hypertension plus diabetes (OR 3.80; 95% CI 1.97-7.32) and the combination of cardiovascular with pulmonary comorbidity (OR 3.18; 95% CI 1.57-6.46). Patients with EC who underwent dCRT had a poorer prognosis than those who underwent nCRT plus surgery, irrespective of age, number, and type of comorbidities. In contrast, for patients with squamous cell carcinoma with ≥ 2 comorbidities or age ≥ 75 years, OS was comparable between both groups (hazard ratio [HR] 1.52; 95% CI 0.78-2.97; and HR 0.73; 95% CI 0.13-4.14).

CONCLUSIONS: Histological tumor type should be acknowledged in treatment choices for patients with esophageal cancer. Neoadjuvant chemoradiotherapy plus surgery should basically be advised as treatment of choice for operable esophageal adenocarcinoma patients. For patients with esophageal squamous cell carcinoma with ≥ 2 comorbidities or age ≥ 75 years, dCRT may be the preferred strategy.

Original language	English
Pages (from-to)	986-995
Number of pages	10
Journal	Annals of Surgical Oncology
Volume	26
Issue number	4
DOIs	https://doi.org/10.1245/s10434-019-07181-6
Publication status	Published - Apr-2019

Keywords

CO-MORBIDITY
DEFINITIVE CHEMORADIOTHERAPY
SURGERY
CHEMORADIATION
MORTALITY
RADIOTHERAPY
CARCINOMA
THERAPY
CHEMOTHERAPY
CARBOPLATIN

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Faiz, Z., van Putten, M., Verhoeven, R. H. A., van Sandick, J. W., Nieuwenhuijzen, G. A. P., van der Sangen, M. J. C., Lemmens, V. E. P. P., Wijnhoven, B. P. L., & Plukker, J. T. M. (2019). Impact of Age and Comorbidity on Choice and Outcome of Two Different Treatment Options for Patients with Potentially Curable Esophageal Cancer. Annals of Surgical Oncology, 26(4), 986-995. https://doi.org/10.1245/s10434-019-07181-6

@article{975f03312db94e909a0dd5841aeea7b0,

title = "Impact of Age and Comorbidity on Choice and Outcome of Two Different Treatment Options for Patients with Potentially Curable Esophageal Cancer",

abstract = "PURPOSE: This study was designed to assess the impact of age and comorbidity on choice and outcome of definitive chemoradiotherapy (dCRT) or neoadjuvant chemoradiotherapy plus surgery.METHODS: In this population-based study, all patients with potentially curable EC (cT1N+/cT2-3, TX, any cN, cM0) diagnosed in the South East of the Netherlands between 2004 and 2014 were included. Kaplan-Meier method with log-rank tests and multivariable Cox regression analysis were used to compare overall survival (OS).RESULTS: A total of 702 patients was included. Age ≥ 75 years and multiple comorbidities were associated with a higher probability for dCRT (odds ratio [OR] 8.58; 95% confidence interval [CI] 4.72-15.58; and OR 3.09; 95% CI 1.93-4.93). The strongest associations were found for the combination of hypertension plus diabetes (OR 3.80; 95% CI 1.97-7.32) and the combination of cardiovascular with pulmonary comorbidity (OR 3.18; 95% CI 1.57-6.46). Patients with EC who underwent dCRT had a poorer prognosis than those who underwent nCRT plus surgery, irrespective of age, number, and type of comorbidities. In contrast, for patients with squamous cell carcinoma with ≥ 2 comorbidities or age ≥ 75 years, OS was comparable between both groups (hazard ratio [HR] 1.52; 95% CI 0.78-2.97; and HR 0.73; 95% CI 0.13-4.14).CONCLUSIONS: Histological tumor type should be acknowledged in treatment choices for patients with esophageal cancer. Neoadjuvant chemoradiotherapy plus surgery should basically be advised as treatment of choice for operable esophageal adenocarcinoma patients. For patients with esophageal squamous cell carcinoma with ≥ 2 comorbidities or age ≥ 75 years, dCRT may be the preferred strategy.",

keywords = "CO-MORBIDITY, DEFINITIVE CHEMORADIOTHERAPY, SURGERY, CHEMORADIATION, MORTALITY, RADIOTHERAPY, CARCINOMA, THERAPY, CHEMOTHERAPY, CARBOPLATIN",

author = "Z Faiz and {van Putten}, M and Verhoeven, {R H A} and {van Sandick}, {J W} and Nieuwenhuijzen, {G A P} and {van der Sangen}, {M J C} and Lemmens, {V E P P} and Wijnhoven, {B P L} and Plukker, {J T M}",

year = "2019",

month = apr,

doi = "10.1245/s10434-019-07181-6",

language = "English",

volume = "26",

pages = "986--995",

journal = "Annals of Surgical Oncology",

issn = "1068-9265",

publisher = "Springer",

number = "4",

}

Faiz, Z, van Putten, M, Verhoeven, RHA, van Sandick, JW, Nieuwenhuijzen, GAP, van der Sangen, MJC, Lemmens, VEPP, Wijnhoven, BPL & Plukker, JTM 2019, 'Impact of Age and Comorbidity on Choice and Outcome of Two Different Treatment Options for Patients with Potentially Curable Esophageal Cancer', Annals of Surgical Oncology, vol. 26, no. 4, pp. 986-995. https://doi.org/10.1245/s10434-019-07181-6

TY - JOUR

T1 - Impact of Age and Comorbidity on Choice and Outcome of Two Different Treatment Options for Patients with Potentially Curable Esophageal Cancer

AU - Faiz, Z

AU - van Putten, M

AU - Verhoeven, R H A

AU - van Sandick, J W

AU - Nieuwenhuijzen, G A P

AU - van der Sangen, M J C

AU - Lemmens, V E P P

AU - Wijnhoven, B P L

AU - Plukker, J T M

PY - 2019/4

Y1 - 2019/4

N2 - PURPOSE: This study was designed to assess the impact of age and comorbidity on choice and outcome of definitive chemoradiotherapy (dCRT) or neoadjuvant chemoradiotherapy plus surgery.METHODS: In this population-based study, all patients with potentially curable EC (cT1N+/cT2-3, TX, any cN, cM0) diagnosed in the South East of the Netherlands between 2004 and 2014 were included. Kaplan-Meier method with log-rank tests and multivariable Cox regression analysis were used to compare overall survival (OS).RESULTS: A total of 702 patients was included. Age ≥ 75 years and multiple comorbidities were associated with a higher probability for dCRT (odds ratio [OR] 8.58; 95% confidence interval [CI] 4.72-15.58; and OR 3.09; 95% CI 1.93-4.93). The strongest associations were found for the combination of hypertension plus diabetes (OR 3.80; 95% CI 1.97-7.32) and the combination of cardiovascular with pulmonary comorbidity (OR 3.18; 95% CI 1.57-6.46). Patients with EC who underwent dCRT had a poorer prognosis than those who underwent nCRT plus surgery, irrespective of age, number, and type of comorbidities. In contrast, for patients with squamous cell carcinoma with ≥ 2 comorbidities or age ≥ 75 years, OS was comparable between both groups (hazard ratio [HR] 1.52; 95% CI 0.78-2.97; and HR 0.73; 95% CI 0.13-4.14).CONCLUSIONS: Histological tumor type should be acknowledged in treatment choices for patients with esophageal cancer. Neoadjuvant chemoradiotherapy plus surgery should basically be advised as treatment of choice for operable esophageal adenocarcinoma patients. For patients with esophageal squamous cell carcinoma with ≥ 2 comorbidities or age ≥ 75 years, dCRT may be the preferred strategy.

AB - PURPOSE: This study was designed to assess the impact of age and comorbidity on choice and outcome of definitive chemoradiotherapy (dCRT) or neoadjuvant chemoradiotherapy plus surgery.METHODS: In this population-based study, all patients with potentially curable EC (cT1N+/cT2-3, TX, any cN, cM0) diagnosed in the South East of the Netherlands between 2004 and 2014 were included. Kaplan-Meier method with log-rank tests and multivariable Cox regression analysis were used to compare overall survival (OS).RESULTS: A total of 702 patients was included. Age ≥ 75 years and multiple comorbidities were associated with a higher probability for dCRT (odds ratio [OR] 8.58; 95% confidence interval [CI] 4.72-15.58; and OR 3.09; 95% CI 1.93-4.93). The strongest associations were found for the combination of hypertension plus diabetes (OR 3.80; 95% CI 1.97-7.32) and the combination of cardiovascular with pulmonary comorbidity (OR 3.18; 95% CI 1.57-6.46). Patients with EC who underwent dCRT had a poorer prognosis than those who underwent nCRT plus surgery, irrespective of age, number, and type of comorbidities. In contrast, for patients with squamous cell carcinoma with ≥ 2 comorbidities or age ≥ 75 years, OS was comparable between both groups (hazard ratio [HR] 1.52; 95% CI 0.78-2.97; and HR 0.73; 95% CI 0.13-4.14).CONCLUSIONS: Histological tumor type should be acknowledged in treatment choices for patients with esophageal cancer. Neoadjuvant chemoradiotherapy plus surgery should basically be advised as treatment of choice for operable esophageal adenocarcinoma patients. For patients with esophageal squamous cell carcinoma with ≥ 2 comorbidities or age ≥ 75 years, dCRT may be the preferred strategy.

KW - CO-MORBIDITY

KW - DEFINITIVE CHEMORADIOTHERAPY

KW - SURGERY

KW - CHEMORADIATION

KW - MORTALITY

KW - RADIOTHERAPY

KW - CARCINOMA

KW - THERAPY

KW - CHEMOTHERAPY

KW - CARBOPLATIN

U2 - 10.1245/s10434-019-07181-6

DO - 10.1245/s10434-019-07181-6

M3 - Article

C2 - 30719634

SN - 1068-9265

VL - 26

SP - 986

EP - 995

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

IS - 4

ER -

Impact of Age and Comorbidity on Choice and Outcome of Two Different Treatment Options for Patients with Potentially Curable Esophageal Cancer

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