title: Increased resection rates and survival among patients aged 75 years and older with esophageal cancer: a Dutch nationwide population-based study.
abstract: BACKGROUND
  The incidence of esophageal cancer has grown over the recent decades and 30% of esophageal cancer patients are now 75 years or older at the time of diagnosis. The aim of this study was to evaluate trends in management and survival of patients aged 75 years or older with esophageal cancer.
  
  
  METHODS
  In the Netherlands cancer registry, we identified all patients aged 75 years or older who were diagnosed with esophageal cancer between 1989 and 2008. Trends in management and survival were analyzed by time period (1989-2001 vs. 2002-2008), TNM stage, and age (75-79, 80-84, and 85+ years). χ2 testing was used to analyze time trends in treatment, Kaplan-Meier analysis and log-rank testing to estimate survival, and Cox regression model to calculate hazard ratios for death.
  
  
  RESULTS
  Some 7,253 patients were included in the study. The surgical resection rate increased over the 1989-2008 period from 8.9 to 12.6% (p=0.028), especially among patients aged 75-79 years (44.6 vs. 55.4%, p<0.001) and patients with TNM stage I disease (12.7 vs. 22.0%, p<0.001). The use of definitive chemoradiotherapy (CRT) also increased (0.19 vs. 2.20%, p<0.001). Whereas the use of chemotherapy as a single-modality treatment more than doubled (0.64 vs. 1.54%, p=0.004), that of radiotherapy alone decreased (38.1 vs. 31.6%, p<0.001). Although median survival time was marginally higher in the 2002-2008 period than in 1989-2001, overall 5 year survival rates remained low at 6 and 5%, respectively (p<0.001). Five-year survival rate after surgery increased from 16 to 30% (p<0.001).
  
  
  CONCLUSIONS
  In patients of 75 years or older, surgical treatment and use of definitive CRT have increased between 1989 and 2008. Also, an increase in the use of chemotherapy as a single modality was noted. Overall 5 year survival for all cancer patients was stable but remained poor, while survival of patients who underwent esophagectomy improved significantly in the Netherlands since 1989.
authors.affiliation: Department of Surgery, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
authors.forename: Zohra
authors.initials: Z
authors.lastname: Faiz
authors.forename: Valery E P P
authors.initials: VE
authors.lastname: Lemmens
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
authors.forename: Grard A P
authors.initials: GA
authors.lastname: Nieuwenhuijzen
authors.forename: Michel W J M
authors.initials: MW
authors.lastname: Wouters
authors.forename: Tom
authors.initials: T
authors.lastname: Rozema
authors.forename: Jan Willem W
authors.initials: JW
authors.lastname: Coebergh
authors.forename: Bas P L
authors.initials: BP
authors.lastname: Wijnhoven
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D003131:Combined Modality Therapy / Q000706:statistics & numerical data / Q000639:trends; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016629:Esophagectomy / Q000401:mortality / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents