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.
