title: Determinants in decision making for curative treatment and survival in patients with resectable oesophageal cancer in the Netherlands: a population-based study.
abstract: BACKGROUND
  Preferred treatment for resectable oesophageal cancer is surgery with or without neoadjuvant treatment. However, oesophageal surgery has high morbidity and in vulnerable patients with co-morbidity other treatment modalities can be proposed. We examined determinants in decision making for surgery and factors affecting survival in patients with resectable oesophageal cancer in southern Netherlands.
  
  
  METHODS
  All patients with resectable (T1-3, N0-1, M0-1A) oesophageal cancer (n=849) diagnosed between 2003 and 2010 were selected from the population-based data of the Eindhoven Cancer Registry. Logistic regression analysis and multivariable Cox survival analysis were conducted to examine determinants of surgery and survival.
  
  
  RESULTS
  Forty-five percent of the patients underwent surgery. In multivariable survival analysis only surgery, chemoradiation alone and tumour stage influenced overall survival (OS). Patients aged ≥ 70 yrs, a low socioeconomic status (SES), one or more co-morbidities, cT1-tumours, cN1-tumours, a squamous-cell carcinoma, and those with a proximal tumour were significantly less often offered surgical resection. Older patients and patients with cT1 tumours were less likely to receive chemoradiation alone. Patients with clinically positive lymph nodes or a proximal tumour were more likely to receive chemoradiation alone.
  
  
  CONCLUSIONS
  Treatment modalities including surgery and chemoradiation alone as well as stage of disease were independent predictors of a better OS in patients with potentially resectable oesophageal cancer. Therefore, the decision to perform potentially curative treatment is of crucial importance to improve OS for patients with potentially resectable oesophageal cancer. Although age and SES had no significant influence on overall survival, a higher age and low SES negatively influenced the probability to propose potentially curative treatment.
authors.affiliation: Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Koëter
authors.affiliation: Comprehensive Cancer Centre, Eindhoven, The Netherlands.
authors.forename: L N
authors.initials: LN
authors.lastname: van Steenbergen
authors.affiliation: Comprehensive Cancer Centre, Eindhoven, The Netherlands; Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: V E P P
authors.initials: VE
authors.lastname: Lemmens
authors.affiliation: Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Surgery, Maastricht University Medical Centre, The Netherlands.
authors.forename: H J T
authors.initials: HJ
authors.lastname: Rutten
authors.affiliation: Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands.
authors.forename: J A
authors.initials: JA
authors.lastname: Roukema
authors.affiliation: Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands. Electronic address: grard.nieuwenhuijzen@catharinaziekenhuis.nl.
authors.forename: G A P
authors.initials: GA
authors.lastname: Nieuwenhuijzen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009426:Netherlands; D010818:Practice Patterns, Physicians'; D012307:Risk Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis
keywords: Curative surgery; Oesophageal cancer; Population-based study; Survival