The role of diabetes and other co-morbidities on survival after esophageal cancer surgery in a population-based study.
Backemar Lovisa,Djärv Therese,Wikman Anna,Johar Asif,Ross Paul,Lagergren Pernilla,Lagergren Jesper
American journal of surgery
BACKGROUND:There is limited knowledge on how diabetes and other comorbidities influence the survival of patients undergoing curative esophageal cancer surgery. METHODS:A population-based and prospective cohort study included patients who underwent surgical resection for esophageal or cardia cancer in Sweden from 2001 to 2005, with follow-up until 2011. Associations between diabetes and other comorbidities in relation to postoperative mortality were analyzed using Cox proportional-hazards regression with adjustment for potential confounding factors. RESULTS:Among 609 patients, 67 (11%) with diabetes had no increased risk for mortality compared with those without diabetes (hazard ratio, .81; 95% confidence interval, .60 to 1.09). Compared with patients without any predefined comorbidities, those with 1 (hazard ratio, 1.15; 95% confidence interval, .93 to 1.43) or ≥2 comorbidities (hazard ratio, 1.05; 95% confidence interval, .83 to 1.33) had no statistically significantly increased risk for mortality. CONCLUSIONS:This study revealed no strongly increased risk for mortality in patients with diabetes or other comorbidities selected for esophageal cancer surgery.
Does chemoradiotherapy benefit elderly patients with esophageal squamous cell cancer? A propensity-score matched analysis on multicenter data (3JECROG R-03A).
Chen Mingqiu,Liu Xiaohong,Han Chun,Wang Xin,Zhao Yidian,Pang Qingsong,Sun Xinchen,Li Gaofeng,Zhang Kaixian,Li Ling,Qiao Xueying,Lin Yu,Chen Junqiang,Xiao Zefen
BACKGROUND:The aim of the present study was to assess the efficacy of concurrent chemoradiotherapy (CRT) or radiotherapy alone (RT-alone) in elderly patients with esophageal squamous cell carcinoma (ESCC). METHODS:The clinical data of patients with ESCC treated with RT-alone or CRT were collected and retrospectively reviewed. The 1-, 3- and 5-year overall survival (OS) rates and the clinical characteristics correlated with survival were analyzed statistically. Propensity score matching (PSM) analyses were used to compensate for differences in baseline characteristics between the CRT and RT-alone groups to confirm the survival difference. RESULTS:A total of 729 patients fulfilling the inclusion criteria were reviewed. Diabetes, primary tumor volume (pTV), primary tumor location (pTLo), clinical T stage,(cT) clinical N stage (cN), clinical M stage (cM) and short-term response to RT were independent factors influencing OS (P = 0.002-0.044). The 5-year OS rate was 26.6, 26.0 and 30.1% in the whole cohort, RT-alone and CRT groups, respectively. The survival difference between RT alone and CRT was not significant before or following PSM. Compared with the corresponding subgroups treated with RT alone, CRT significantly benefited patients with diabetes (P = 0.003), cT4 (P = 0.030) and cN0 (P = 0.049), whereas no benefit was identified between CRT and RT alone in the other subgroups, including cT1-3, cN1, cM, pTLo, pTV, age and gender. CONCLUSIONS:CRT with the current chemotherapy regimens may not improve the survival of elderly ESCC patients compared to RT-alone, except in patients with cT4 stage, cN0 stage or diabetes. However, due to the limitation of the retrospective nature of the current study, further clinical trials are required for confirmation.