Influence of young age on outcome after esophagectomy for cancer
World Journal of Surgery, 07/25/2012
van Nistelrooij AMJ et al. – A considerable proportion (12 %) of patients diagnosed with resectable esophageal carcinoma were <50 years. Phenotypic tumor characteristics and disease–specific survival were comparable for the two age groups.Methods
- Patients diagnosed with esophageal carcinoma who underwent esophagectomy between January 1990 and December 2010 in a single institution were selected from a prospective database.
- Patients aged <50 years at diagnosis (n = 163) were compared with those ≥50 years (n = 1151) with respect to clinicopathologic stage and oncologic outcome.
- Younger patients had less co–morbidity (p < 0.001).
- There were no significantly differences in tumor localization, histology, differentiation, or TNM stage in the two groups.
- In both groups, 37 % of the patients underwent neoadjuvant chemo(radio)therapy.
- One or more nonsurgical complications developed in 53 % of the older group versus 42 % in the younger group (p = 0.012).
- In–hospital mortality was 6.3 % for patients ≥50 years compared to 1.8 % for younger patients (p = 0.021).
- The 5 year overall survival was significantly better for the younger patients than for those ≥50 years (41 vs. 31 %, p < 0.001), but median disease–specific and disease–free survival did not differ between the groups (37 vs. 30 months, p = 0.140 and 49 vs. 28 months, p = 0.079, respectively).
- Multivariate analysis identified moderate, poorly, and undifferentiated tumors; tumor–positive resection margins (pR1–2); and TNM stage IIB–IV as independent predictors of disease–specific survival.