[Treatment strategy for stage II/III (non-T4) advanced esophageal cancer in high-risk patients]

We evaluated treatment strategies for Stage II/III (non-T4) advanced esophageal cancer in high-risk (HR) patients and analyzed the relationship between E-PASS scoring system (E-PASS) and HR patients retrospectively. The subjects were 85 patients who received the treatment for Stage II/III (non-T4) advanced esophageal cancer between 2006 and 2010 in our institute. The patients were divided into the HR and non high-risk (NHR) group. In this study, HR patients were defined as satisfying at least one of the following criteria; over 75 years old, performance status ≥ 2, presence of sever heart, respiratory, liver, renal dysfunction and diabetes mellitus. Using these criteria, there were 35 patients (41%) in the HR group. In the HR group, the ratio of surgical treatment was significantly lower than that in the NHR group (p<0.01), and minimal invasive surgery was performed. In the patients who underwent surgery, there was no difference in morbidity rate and overall survival between the HR and the NHR group. A preoperative risk score (PRS) in E-PASS system was positively correlated with HR patients satisfying our classification( rs=0.63, p<0.01). Our results indicated that overall survival of the HR patients was not inferior to that of the NHR patients, even if minimal invasive surgical methods were performed for the HR patients with Stage II/III (non-T4) advanced esophageal cancer. Moreover, we found that our HR classification would be a useful index to decide the treatment for Stage II/III (non-T4) advanced esophageal cancer, as well as the PRS in E-PASS.