Abstract
BACKGROUND: The optimal treatment for elderly patients with esophageal cancer (EC) remains controversial. In the present study, we aimed to investigate whether elderly patients with stage II-III EC could benefit from trimodal therapy. METHODS: The selected elderly patients with stage II-III EC between 2004 and 2015 were included in a retrospective cohort study from the Surveillance, Epidemiology, and End Results database. The patients were divided into two groups based on whether or not they underwent surgery. The inverse probability of treatment weighting (IPTW) analysis was used to balance the confounding factors between the two groups. The Cox regression analysis, the log-rank test, and the Kaplan-Meier curves were conducted to identify the survival benefits of different treatment regimes. RESULTS: A total of 1596 patients were included in this cohort study, in which 278 patients underwent surgery. In the combination of chemoradiotherapy and surgery group, there were more male patients, more patients aged between 75 and 79 years, and more married patients in the surgery group. Moreover, there were more patients with adenomatous carcinoma, more patients with a tumor size of less than 5 cm, and more patients with a T3 stage in the combination group. In the survival analysis, patients in the combination group had a longer overall survival (OS) and EC-specific survival (ECSS). After IPTW analysis, the survival analysis generated similar results. The competitive risk model found that our results were stable. There was still a significant difference in OS and ECSS between the combination group and chemoradiotherapy alone group for esophageal adenocarcinoma (p < 0.001). CONCLUSIONS: Elderly patients with stage II-III EC, especially those with adenocarcinoma, could benefit from the combination of surgery and chemoradiotherapy.