Trends in treatment strategies for esophageal adenocarcinoma in octogenerians: a population-based analysis of 12.224 patients from the German clinical cancer registry group

Introduction/Aims: The optimal treatment approach for octogenarians with esophageal adenocarcinoma remains challenging. This study aims to evaluate the suitability of conventional multimodal therapies for elderly patients and to analyze the current state of care across three different age groups of individuals with esophageal adenocarcinoma (EAC) in Germany.

Methods: Data was obtained from 24 clinical cancer registries in Germany delivered by the German Cancer Registry Group of the Association of German Tumor Centers from 2000-2023. We differentiated patients in three age groups (<65 years, 65-79 years,>80 years) and compared them according to the perioperative and long-term survivals based on different modality treatments.

Results: In total 12.224 patients were included and differentiated in three groups (<65 years: n=5643; 65-79 years: n=5260;>80 years: n=1321). From 2000 to 2022, the proportion of patients>80 years old increased from 3% to 14%. UICC I-III distribution was similar for all age groups p=0.908. Furthermore,>80 years patients were increasingly provided with Chemotherapy (CTx) (<65 years: 54%; 65-79 years: 56%;>80 years: 63%) and surgery only (<65 years: 7%; 65-79 years 10%;>80 years: 17%) compared to younger patients. Overall survival (OS) decreased with higher age group (<65 years: mean 39.6 months; 65-79 years: mean 29.3 months;>80: mean 18 months, p<0.001). In Patients>80 years, the mean OS was longer for surgery only (29 months) compared to CTx (14 months) and definitive radio- chemotherapy (18 months (p<0.005). Multimodal therapy (perioperative Chemotherapy+surgery or radio-chemotherapy+surgery) were underutilized in patients>80 representing only 1% and 7% of all treatment modalities in this age group. However, there was no significanct benefit in survival among multimodal treatment strategies compared to resection only in>80-year-old patients (perioperative Chemotherapy+surgery: p=0.83; radio-chemotherapy+surgery: p=0.56). The 90-days-mortality for esophagus resection was 26% in patients>80 years compared to 5% and 10% for age groups<65 years, 65-79 years. The multivariate analysis shows that the age group>80 is a negative independent prognostic factor for overall survival independent of sex, treatment modality, cN status and resection margin compared to<65 years (HR: 0.45; 95% CI: 0.39-0.53; p<0.001) and 65-79 years (HR: 0.59; 95% CI: 0.51-0.69; p<0.001).

Conclusion: Octogenarians tend to have poorer survival outcomes at similar tumor stages compared to younger age groups. When curative treatment is considered for this age group, tumor resection proves to be more effective than chemotherapy alone or definitive radio-chemotherapy. Additionally, there is no survival benefit for octogenarians undergoing perioperative chemotherapy or neoadjuvant chemoradiation followed by surgery, compared to those who only receive surgery only.

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Artikel online veröffentlicht:
04. September 2025