A Propensity-Score Matched Analysis to Evaluate Local Treatment Modalities for Esophageal Squamous Cell Carcinoma in...

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 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.

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.

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.