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Impact of Age on Surgical Outcomes for Locally Advanced Esophageal Cancer.

Publication ,  Journal Article
Farrow, NE; Raman, V; Jawitz, OK; Voigt, SL; Tong, BC; Harpole, DH; D'Amico, TA
Published in: Ann Thorac Surg
March 2021

BACKGROUND: Older patients are often considered high-risk surgical candidates for locally advanced esophageal cancer, and the benefit of surgery in this population is unclear. This national analysis examines the effect of age on esophagectomy outcomes and compares surgery versus chemoradiation in older patients. METHODS: The National Cancer Database was used to identify patients with clinical stage II to III esophageal adenocarcinoma undergoing surgery or definitive chemoradiation between 2004 and 2015. Restricted cubic splines were used to examine the relationship between age and survival after esophagectomy, and maximally selected rank statistics were used to identify an age at which survival worsened. We used Cox proportional hazard models including an interaction term between age and treatment to compare overall survival, as well as survival of patients receiving esophagectomy versus definitive chemoradiation. RESULTS: Of 17,495 patients, 11,680 underwent esophagectomy and 5815 received chemoradiation. Survival after esophagectomy worsened with increasing age and decreased considerably after age 73 (hazard ratio = 1.05, 95% confidence interval, 1.04-1.06, per increasing year after 73 versus hazard ratio = 1.01, 95% confidence interval, 1.00-1.01, per increasing year to 73; both P < .001). Chemoradiation was increasingly used over surgery as age increased. The interaction between age and treatment was significant, and a graph of this interaction demonstrated a survival benefit for surgery over chemoradiation at most ages, including octogenarians. CONCLUSIONS: Survival worsens with age after esophagectomy for locally advanced esophageal cancer. However, esophagectomy is associated with improved survival compared with definitive chemoradiation at most ages, including octogenarians. Esophagectomy may be considered over chemoradiation for patients who can tolerate surgery regardless of age.

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Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

March 2021

Volume

111

Issue

3

Start / End Page

996 / 1003

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Risk Factors
  • Respiratory System
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Humans
  • Female
  • Esophagectomy
 

Citation

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Farrow, N. E., Raman, V., Jawitz, O. K., Voigt, S. L., Tong, B. C., Harpole, D. H., & D’Amico, T. A. (2021). Impact of Age on Surgical Outcomes for Locally Advanced Esophageal Cancer. Ann Thorac Surg, 111(3), 996–1003. https://doi.org/10.1016/j.athoracsur.2020.06.055
Farrow, Norma E., Vignesh Raman, Oliver K. Jawitz, Soraya L. Voigt, Betty C. Tong, David H. Harpole, and Thomas A. D’Amico. “Impact of Age on Surgical Outcomes for Locally Advanced Esophageal Cancer.Ann Thorac Surg 111, no. 3 (March 2021): 996–1003. https://doi.org/10.1016/j.athoracsur.2020.06.055.
Farrow NE, Raman V, Jawitz OK, Voigt SL, Tong BC, Harpole DH, et al. Impact of Age on Surgical Outcomes for Locally Advanced Esophageal Cancer. Ann Thorac Surg. 2021 Mar;111(3):996–1003.
Farrow, Norma E., et al. “Impact of Age on Surgical Outcomes for Locally Advanced Esophageal Cancer.Ann Thorac Surg, vol. 111, no. 3, Mar. 2021, pp. 996–1003. Pubmed, doi:10.1016/j.athoracsur.2020.06.055.
Farrow NE, Raman V, Jawitz OK, Voigt SL, Tong BC, Harpole DH, D’Amico TA. Impact of Age on Surgical Outcomes for Locally Advanced Esophageal Cancer. Ann Thorac Surg. 2021 Mar;111(3):996–1003.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

March 2021

Volume

111

Issue

3

Start / End Page

996 / 1003

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Risk Factors
  • Respiratory System
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Humans
  • Female
  • Esophagectomy