Localized Gastroesophageal Adenocarcinoma in the Elderly: Is Age a Factor Associated with Suboptimal Treatment?

Abstract

Introduction: Gastroesophageal adenocarcinoma is relatively common in elderly patients as the incidence increases with age. However, the optimal treatment approach is not well established in this group of patients. The aim of this study is to review our experience for localized gastroesophageal adenocarcinoma in patients aged ≥ 80 years and to assess association between patient characteristics, clinical factors and overall survival in order to optimize the therapeutic approaches for this population. Methods and Materials: patients ≥ 80 years old treated for localized gastroesophageal adenocarcinoma were retrospectively analyzed. Survival curves were estimated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards regression models were applied to assess the association between patient characteristics and overall survival (OS). Factors that were significant in the multivariate model were included in the final reduced model. Results: 127 patients ≥ 80 years old, were included in this study with median age of 83 years. The median follow-up time was 3.2 years, and median OS was 2.5 years (95% CI: 2.0-3.1 years). Independent prognostic factors for OS were Eastern Cooperative Oncology Group (ECOG) performance status (PS) (p=0.003), baseline clinical stage (p=0.01), and surgery (p=0.001). ECOG PS, tumor location, baseline stage, tumor grade and surgery were included in the final reduced model. Conclusion: Surgical treatment, can improve survival in elderly patients. Therapeutic decisions should be based on the patients’ general condition rather that age alone.