Outcome of Trimodal Therapy in Elderly Patients with Esophageal Cancer: Prognostic Value of the Charlson Comorbidity Index

Bernardi, Daniele; Asti, Emanuele; Aiolfi, Alberto; Bonitta, Gianluca; Luporini, Alberto; Bonavina, Luigi

doi:10.21873/anticanres.12420

Cited by 9 publications

(3 citation statements)

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“…The propensity to prescribe multimodal treatment was increased in patients aged<70 years in good general condition (low ASA score) with advanced cancer (cT3-4/cN+). Accordingly, Charlson's comorbidity index ( [18]) was the most important predictor of tolerance to nCRT in an Italian series aged >65 years with esophageal squamous cell carcinoma and adenocarcinoma [19]. Interestingly, the proportion of patients receiving standard multimodal care (perioperative/adjuvant treatment and surgery) was relatively low in Canadian series aged 75 years or older, affected by either gastric or esophageal carcinoma (14%) [20] or localized gastric or gastroesophageal junction cancer (13%) [21].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Treatment of EGJ Cancer within or outside Clinical Trials: Does the Setting Matter? A Monocentric Prospective Observational Study

et al. 2023

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Introduction. RCTs support neoadjuvant chemoradiotherapy (nCRT) followed by surgery in Locally Advanced Esophago-Gastric Junction (LA-EGJ) adenocarcinoma. However, RCTs are performed in highly controlled settings with limited representativeness of real-life patients (RLS). Aim: To compare the outcomes in RLS and clinical trial settings. Methods. The outcomes of RLS, which comprised 125 patients consequently treated for LA-EGJ adenocarcinoma between 2012 and 2017, were compared with the phase II trial (PIIS), performed on 65 patients from 2003 to 2011. Results. About half of RLS (51.2%) were treated with nCRT according to VR-protocol, 20.8% with standard-CRT according to CROSS/Al-Sarraf, 20% with CT alone. pCR was 36.8%, 28.6% and 9.1% after VR-protocol, standard-CRT, and chemotherapy respectively (p=0.082), while three-year overall survival (OS) was 58.6% (95% CI 43.2-71.1%), 32.8% (14.6-52.4%) and 44.8% (21.3-65.9%) respectively (p=0.030). With respect to PIIS, RLS had a higher proportion of cN+ (94% versus 54%; p<0.001), and a lower proportion of pCR after CT/CRT (23% versus 39%; p=0.041). Three-year OS was slightly higher, although not significantly, in PIIS (58.9%, 45.1-70.2%) than RLS (47.9%, 37.4-57.7%) and nearly identical to 3-year OS in RLS treated with VR-protocol. Discussion/Conclusion. Real-life patients with EGJ adenocarcinoma have more advanced cancer at baseline, lower pathologic response to neoadjuvant treatment than patients enrolled in clinical trials, but similar survival.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Treatment of EGJ Cancer within or outside Clinical Trials: Does the Setting Matter? A Monocentric Prospective Observational Study

et al. 2023

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“…Regarding the adjuvant treatments, this association is not surprising since the efficacy of adjuvant treatments to prevent recurrence and metastasis, and improve survival is the reason for giving adjuvant therapy in the first place[ 3 - 5 , 15 , 16 , 21 ]. Regarding the CCI, Bernardi et al [ 22 ] showed that patients with esophageal cancer who completed their treatment plan had a lower CCI than those who eventually dropped out, affecting the prognosis. Yamashita et al [ 23 ] and Aoyama et al [ 24 ] showed that the CCI was correlated with the prognosis of patients who undergo curative resection of esophageal carcinoma.…”

Section: Discussionmentioning

confidence: 99%

Short- (30-90 days) and mid-term (1-3 years) outcomes and prognostic factors of patients with esophageal cancer undergoing surgical treatments

Shi¹,

Mei²,

Shi³

2022

WJCC

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BACKGROUND The factors influencing the prognosis of patients with esophageal cancer vary among studies and are still poorly known. AIM To determine the factors associated with survival in patients with esophageal cancer. METHODS This retrospective study included patients with esophageal cancer admitted between January 2017 and March 2020 at Heping Hospital Affiliated to Changzhi Medical College. All patients were treated according to the available guidelines. Follow-up was censored in October 2020. Univariable and multivariable Cox regression analyses were used to determine the independent risk factors for overall survival (OS). RESULTS In total, 307 patients were included. Their median age was 64 (range, 44-79) years, 63.5% were male, and the median disease course was 2 (0.1-36) months. The median tumor size was 3 (0-10) cm. Most patients were T3 (29.6%), N0 (70.0%). Most tumors were grade 2 (48.2%), and 87.3% were squamous cell carcinoma. The in-hospital mortality was 16.9%, the 30-day mortality was 19.9%, and the 90-day mortality was 25.4%. The cumulative OS rates at the last follow-up were 82.1% (95%CI: 67.7%-96.5%) for stage 0/I/II and 47.4% (95%CI: 16.5-78.6%) for stage III/IVA ( P < 0.001). The multivariable analysis showed that creatinine levels (HR = 1.02, 95%CI: 1.00-1.03, P = 0.050), pTNM III/IVA (HR = 4.19, 95%CI: 2.19-8.01, P < 0.001), adjuvant radiotherapy and/or chemotherapy (HR = 0.23, 95%CI: 0.11-0.49), and the Comprehensive Complication Index (CCI) (HR = 1.02, 95%CI: 1.004-1.03, P = 0.011) were independently associated with OS. CONCLUSION The survival of patients with esophageal cancer is poor, especially those with pTNM III/IVA. pTNM stage III/IVA, CCI, and adjuvant therapy (radiotherapy and/or chemotherapy) are independently associated with OS.

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Management of Locally Advanced and Metastatic Esophageal Cancer in the Older Population

2018

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Outcome of Trimodal Therapy in Elderly Patients with Esophageal Cancer: Prognostic Value of the Charlson Comorbidity Index

Abstract: Routine use of the CCI may help in the pretreatment risk stratification of elderly patients with esophageal carcinoma.

Cited by 9 publications

References 0 publications

Treatment of EGJ Cancer within or outside Clinical Trials: Does the Setting Matter? A Monocentric Prospective Observational Study

Treatment of EGJ Cancer within or outside Clinical Trials: Does the Setting Matter? A Monocentric Prospective Observational Study

Short- (30-90 days) and mid-term (1-3 years) outcomes and prognostic factors of patients with esophageal cancer undergoing surgical treatments

Management of Locally Advanced and Metastatic Esophageal Cancer in the Older Population

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