Surgical versus Non-Surgical Treatment for Esophageal Squamous Cell Carcinoma in Patients Older than 70 years: A Propensity Score Matching Analysis

Background: With the rising life expectancy and an ageing population, it has become increasingly important to investigate treatments suitable for older adult patients with esophageal cancer. This study investigated whether older adult patients who underwent esophagectomy had better clinical outcomes than those who were non-surgically treated. Materials and methods: We retrospectively analyzed patients with esophageal squamous cell carcinoma (ESCC) who were 70 years or older and underwent esophagectomy, radiotherapy (RT), and/or chemotherapy (CT) from January 2018 to December 2019. Patients were divided into two groups: the surgery group (S group) and non-surgery group (NS group). Then compared the clinical outcomes of the two groups. Results: After a median follow-up duration of 36.6 months, the S group showed better OS. The 3-year OS was 59% in the S group and 27% in the NS group (HR, 0.397; 95% CI, 0.278-0.549; P<0.0001). In the S group, the median progression free survival was 38.3 months (95% CI, 30.6-46.1) compared to 12.3 months in the NS group (HR, 0.511; 95% CI, 0.376-0.695; P<0.0001). In addition, the number of adverse events in the NS group was higher than that in the S group (P<0.001) Conclusion: Overall, patients with ESCC ≥70 years who underwent esophagectomy had significantly better clinical outcomes than those who underwent non-surgical treatment with RT and/or CT.