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Survival Impacts of Impaired Lung Functions and Comorbidities on Elderly Esophageal Cancer Patients

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Abstract

Background

Preoperative physiological assessments are crucial for optimizing clinical outcomes, especially those of elderly esophageal cancer (EC) patients who are generally frail and at the high risk of mortality.

Methods

Patients who underwent surgery for EC between 2004 and 2018 were retrospectively reviewed. Patients were categorized into elderly (>70 years) or non-elderly (≤70 years) groups. Various physiological parameters including the Charlson Comorbidity Index (CCI), immunonutritional parameters and pulmonary functions were studied. Pulmonary functions included %vital capacity (VC) and forced expiratory volume in one second (FEV1.0) and FEV1.0%. The thresholds were set as the lowest quartile (100% for %VC and 2L for FEV1.0) in this cohort. Multivariate Cox hazards models were applied to determine independent predictors of non-EC-related deaths.

Results

In total, 824 patients were included (elderly; n = 306, non-elderly; n = 518). Elderly patients had a significantly lower 5-year OS rate than non-elderly patients (53.3% vs. 57.2%, P = 0.03), mainly due to increased risk of death from non-EC related causes. In the elderly group, multivariate Cox hazards analysis identified 3 independent predictors of non-EC-related deaths; high CCI (HR 1.98, P=0.006), low %VC (HR 2.01, P = 0.004) and low FEV1.0 (HR 1.6, P=0.048). Elderly patients without risk factors had a significantly better 5-year OS rate (63.5%) than those with 1 (50.0%) or 2–3 (36.3%) risk factors (P <0.01). Deaths due to pulmonary disease rose significantly as the number of risk factors increased (P=0.03).

Conclusions

The severity of comorbidities and pulmonary function impairments are useful for predicting long-term outcomes, especially non-EC-related deaths, in elderly EC patients.

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Abbreviations

EC:

Esophageal cancer

CCI:

Charlson comorbidity index

VC:

Vital capacity

FEV1.0:

Forced expiratory volume in one second

PNI:

Prognostic nutritional index

GPS:

Glasgow prognostic score

CDDP:

Cisplatin

5-FU:

5-Fluorouracil

dCRT:

Definitive chemoradiotherapy

VATS:

Video-assisted transthoracic surgery

C-D:

Clavien–Dindo

OS:

Overall survival

CSS:

Cancer-specific survival

HR:

Hazard ratios

CI:

Confidence intervals

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Funding

This research received no specific grants from any funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Saitama Cancer Center, 780 Komuro Inamachi, , Kitaadachi-Gun, Saitama, 362-0806, Japan

    Kotaro Sugawara, Daiji Oka & Takashi Fukuda

  2. Department of Gastroenterology, Saitama Cancer Center, Saitama, Japan

    Hiroki Hara & Takako Yoshii

Authors
  1. Kotaro Sugawara
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  4. Takako Yoshii
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  5. Takashi Fukuda
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Contributions

The contributions of the authors to this study are as follows: K.S. and T.F. are the authors mainly responsible for the study’s conception and design, acquisition of data, and analysis and interpretation of data. H.H., T.Y. and D.O. contributed mainly to the drafting of the article and to revising it critically for important intellectual content. All authors have no conflicts of interest or financial ties to disclose.

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Correspondence to Kotaro Sugawara.

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Supplementary Information

268_2023_7195_MOESM1_ESM.tiff

Supplementary Figure 1. Causes of death according to age elderly patients had a significantly higher death rate due to pulmonary diseases than non-elderly patients (9.5% vs. 3.7%, P<0.01). (Tiff 7274 kb)

268_2023_7195_MOESM2_ESM.tiff

Supplementary Figure 2. Causes of death according to the number of risk factors in elderly patients deaths due to pulmonary disease rose significantly as the number of risk factors increased. (Tiff 7274 kb)

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Sugawara, K., Oka, D., Hara, H. et al. Survival Impacts of Impaired Lung Functions and Comorbidities on Elderly Esophageal Cancer Patients. World J Surg 47, 3229–3239 (2023). https://doi.org/10.1007/s00268-023-07195-y

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