Qiaofang Li, Mengchang Gao, Yitong Li, Lei Tian, Kuo Wang, Xiaolu Yan
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Overall survival (OS) and cancer-specific survival (CSS) was calculated using the Kaplan-Meier method and compared using the Log rank test.</p><p><strong>Results: </strong>A total of 1588 esophageal squamous cell cancer patients of ≥80 years older between 1975 and 2021 were included in the final study cohort, including 165 (10.4%) patients who underwent CDS and 1423 (89.6%) patients who received radiotherapy (RT) therapy. Univariate and multivariate analyses showed that local treatment modalities were prognostic factors for cause-specific survival (CSS) and overall survival (OS). Patients who received CDS had better CSS (HR = 0.674; 95% CI = 0.544-0.836; P < 0.000) and OS (HR = 0.717; 95% CI = 0.595-0.863; P < 0.000). In the propensity-score matched (PSM) dataset, CDS was associated with better CSS (P < 0.008) and OS (P < 0.011) for patients with ≥80 years older; Subgroup analyses showed the prognostic effect of local treatment modalities was significantly influenced by Age. Nevertheless, no differences were observed in CSS (P = 0.584) and OS (P = 0.434) for patients with ≥85 years old.</p><p><strong>Conclusion: </strong>In conclusion, CDS was the preferred treatment for esophageal squamous cell cancer patients with 80-84 years older, and there was no difference between CDS and RT for patients with≥85 years older. This study highlight the value of different local treatments for esophageal squamous cell carcinoma over 80 years patients, especially for ≥85 years older. Further studies are needed to understand drivers of this bias and enhance equality in old patient treatment.</p>","PeriodicalId":48841,"journal":{"name":"Clinical Interventions in Aging","volume":"20 ","pages":"1223-1234"},"PeriodicalIF":3.7000,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12350591/pdf/","citationCount":"0","resultStr":"{\"title\":\"A Propensity-Score Matched Analysis to Evaluate Local Treatment Modalities for Esophageal Squamous Cell Carcinoma in Over 80 years on A SEER Database.\",\"authors\":\"Qiaofang Li, Mengchang Gao, Yitong Li, Lei Tian, Kuo Wang, Xiaolu Yan\",\"doi\":\"10.2147/CIA.S511737\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>The aim of this study was to investigate the impact of Local treatment modalities on the survival of≥80 years older patients with squamous cell esophageal cancer, including cancer-directed surgery (CDS) or radiotherapy (RT).</p><p><strong>Patients and methods: </strong>Patients in the Surveillance Epidemiology and End Results (SEER) database were divided into CDS Group and RT Group D according to different Local treatment modalities. Propensity score matching (PSM) was performed to adjust for baseline differences between the two groups. Overall survival (OS) and cancer-specific survival (CSS) was calculated using the Kaplan-Meier method and compared using the Log rank test.</p><p><strong>Results: </strong>A total of 1588 esophageal squamous cell cancer patients of ≥80 years older between 1975 and 2021 were included in the final study cohort, including 165 (10.4%) patients who underwent CDS and 1423 (89.6%) patients who received radiotherapy (RT) therapy. Univariate and multivariate analyses showed that local treatment modalities were prognostic factors for cause-specific survival (CSS) and overall survival (OS). Patients who received CDS had better CSS (HR = 0.674; 95% CI = 0.544-0.836; P < 0.000) and OS (HR = 0.717; 95% CI = 0.595-0.863; P < 0.000). In the propensity-score matched (PSM) dataset, CDS was associated with better CSS (P < 0.008) and OS (P < 0.011) for patients with ≥80 years older; Subgroup analyses showed the prognostic effect of local treatment modalities was significantly influenced by Age. Nevertheless, no differences were observed in CSS (P = 0.584) and OS (P = 0.434) for patients with ≥85 years old.</p><p><strong>Conclusion: </strong>In conclusion, CDS was the preferred treatment for esophageal squamous cell cancer patients with 80-84 years older, and there was no difference between CDS and RT for patients with≥85 years older. This study highlight the value of different local treatments for esophageal squamous cell carcinoma over 80 years patients, especially for ≥85 years older. 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引用次数: 0
摘要
目的：本研究的目的是探讨局部治疗方式对≥80岁高龄鳞状细胞食管癌患者生存的影响，包括癌症定向手术（CDS）或放疗（RT）。患者和方法：SEER （Surveillance Epidemiology and End Results）数据库中的患者根据局部治疗方式的不同分为CDS组和RT D组。采用倾向评分匹配（PSM）来调整两组之间的基线差异。采用Kaplan-Meier法计算总生存期（OS）和肿瘤特异性生存期（CSS），并采用Log rank检验进行比较。结果：1975年至2021年间，共有1588例≥80岁的食管鳞状细胞癌患者被纳入最终研究队列，其中165例（10.4%）患者接受了CDS治疗，1423例（89.6%）患者接受了放疗（RT）治疗。单因素和多因素分析显示，局部治疗方式是影响病因特异性生存（CSS）和总生存（OS）的预后因素。接受CDS治疗的患者CSS （HR = 0.674; 95% CI = 0.544-0.836; P < 0.000）和OS （HR = 0.717; 95% CI = 0.595-0.863; P < 0.000）较好。在倾向评分匹配（PSM）数据集中，年龄≥80岁的患者，CDS与更好的CSS （P < 0.008）和OS （P < 0.011）相关；亚组分析显示，局部治疗方式的预后效果受年龄的显著影响。然而，≥85岁患者的CSS （P = 0.584）和OS （P = 0.434）无差异。结论：结论：年龄80 ~ 84岁的食管鳞状细胞癌患者首选CDS治疗，年龄≥85岁的患者CDS与RT治疗无差异。本研究强调了不同局部治疗对80岁以上食管鳞状细胞癌患者的价值，特别是对≥85岁的老年人。需要进一步的研究来了解这种偏见的驱动因素，并提高老年患者治疗的公平性。
A Propensity-Score Matched Analysis to Evaluate Local Treatment Modalities for Esophageal Squamous Cell Carcinoma in Over 80 years on A SEER Database.
Purpose: The aim of this study was to investigate the impact of Local treatment modalities on the survival of≥80 years older patients with squamous cell esophageal cancer, including cancer-directed surgery (CDS) or radiotherapy (RT).
Patients and methods: Patients in the Surveillance Epidemiology and End Results (SEER) database were divided into CDS Group and RT Group D according to different Local treatment modalities. Propensity score matching (PSM) was performed to adjust for baseline differences between the two groups. Overall survival (OS) and cancer-specific survival (CSS) was calculated using the Kaplan-Meier method and compared using the Log rank test.
Results: A total of 1588 esophageal squamous cell cancer patients of ≥80 years older between 1975 and 2021 were included in the final study cohort, including 165 (10.4%) patients who underwent CDS and 1423 (89.6%) patients who received radiotherapy (RT) therapy. Univariate and multivariate analyses showed that local treatment modalities were prognostic factors for cause-specific survival (CSS) and overall survival (OS). Patients who received CDS had better CSS (HR = 0.674; 95% CI = 0.544-0.836; P < 0.000) and OS (HR = 0.717; 95% CI = 0.595-0.863; P < 0.000). In the propensity-score matched (PSM) dataset, CDS was associated with better CSS (P < 0.008) and OS (P < 0.011) for patients with ≥80 years older; Subgroup analyses showed the prognostic effect of local treatment modalities was significantly influenced by Age. Nevertheless, no differences were observed in CSS (P = 0.584) and OS (P = 0.434) for patients with ≥85 years old.
Conclusion: In conclusion, CDS was the preferred treatment for esophageal squamous cell cancer patients with 80-84 years older, and there was no difference between CDS and RT for patients with≥85 years older. This study highlight the value of different local treatments for esophageal squamous cell carcinoma over 80 years patients, especially for ≥85 years older. Further studies are needed to understand drivers of this bias and enhance equality in old patient treatment.
期刊介绍：
Clinical Interventions in Aging, is an online, peer reviewed, open access journal focusing on concise rapid reporting of original research and reviews in aging. Special attention will be given to papers reporting on actual or potential clinical applications leading to improved prevention or treatment of disease or a greater understanding of pathological processes that result from maladaptive changes in the body associated with aging. This journal is directed at a wide array of scientists, engineers, pharmacists, pharmacologists and clinical specialists wishing to maintain an up to date knowledge of this exciting and emerging field.
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