Impact of Age on the Treatment and Survival in Esophagogastric Cancer

• Published in: Annals of surgical oncology 2023-05, Vol.30 (5), p.2716-2725
• Main Authors: Kauppila, Joonas H., Mattsson, Fredrik, Lagergren, Jesper
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cancer; Cohort Studies; Comorbidity; Esophageal cancer; Esophageal Neoplasms - surgery; Humans; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Mortality; Oncology; Patients; Population studies; Proportional Hazards Models; Stomach Neoplasms - surgery; Surgery; Surgical Oncology; Survival; Thoracic Oncology
• ISSN: 1068-9265; 1534-4681; 1534-4681
• DOI: 10.1245/s10434-022-13052-4

Background The age-specific risks of mortality for patients with esophagogastric cancer and their probability of surgical treatment are not well-known. Methods This population-based, nationwide cohort study included all patients with esophageal or gastric (esophagogastric) cancer in Sweden between 1990 and 2013, with follow-up evaluation throughout 2018. Age at diagnosis (exposure) was categorized into nine 5-year groups. The main outcome was 5-year all-cause mortality. The secondary outcomes were 90-day all-cause mortality, 5-year disease-specific mortality, 5-year disease-specific mortality excluding 90-day all-cause mortality, and non-operation. For mortality outcomes, Cox regression provided hazard ratios (HRs) with 95% confidence intervals (95% CIs) adjusted for confounders. For non-operation, logistic regression provided odds ratios (ORs) with 95% CIs. Results Among 28,725 patients, 11,207 (39.0%) underwent surgery. For those who underwent surgery, the HRs of 5-year all-cause mortality were stable before the ages of 65 to 69 years. After that, it gradually increased for patients 65 to 69 years old (HR, 1.13; 95% CI, 1.01–1.26), patients 75 to 79 years old (HR, 1.29; 95% CI, 1.56–1.44), and patients older than 85 years (HR, 1.84; 95% CI, 1.60–2.11) compared with those younger than 50 years. Analyses of age as a continuous variable, other mortality outcomes and stratification by comorbidity and tumor type showed similar results. The odds of non-operation increased for patients 75 to 79 years old (OR, 2.09 [95% CI, 1.84–2.94] for patients 80 to 84 years old and OR, 5.00 [95% CI, 4.31–5.78] for patients ≥85 years old or older), compared with those younger than 50 years. Conclusion Older age, starting from 65 years, is associated with worse survival after surgery for esophagogastric cancer, and from 75 years with lower odds of surgical treatment.