Abstract：
BACKGROUND: The incidence of esophageal and gastric carcinoma (GEC) in elderly patients is increasing, yet patients ≥75 years have historically been underrepresented in clinical trials. We sought to investigate palliative chemotherapy administration patterns and survival outcomes in older adults.
METHODS: A retrospective analysis identified patients aged 65-74 (young-old) and ≥75 years (older-old) diagnosed with advanced GEC. Patient and tumor characteristics were recorded, with descriptive analysis, time-to-event data analysis using Kaplan-Meier curves and multivariate Cox proportional hazards regression analysis performed.
RESULTS: One hundred and ninety-eight \"young-old\" and 109 \'older-old\' patients were identified. Patient characteristics were similar between groups except for Charlson Co-morbidity Index (CCI), with lower co-morbidities in the \"young-old\" compared to \"older-old\" cohort (P < .001; CCI = 0 in 103 (52%) \"young-old\" vs 31 (28%) \"older-old\"). The primary diagnosis in both groups was adenocarcinoma. 119 (60%) \"young-old\" and 25 (23%) \"older-old\" patients received chemotherapy (P < .001). Performance status was the primary explanation for chemotherapy non-receipt in both cohorts; age was the explanation in 21 (25%) \"older-old\" patients and none in the \"young-old\" patients. PFS for first-line systemic therapy in \"young-old\" patients was 6.4 (95% CI 5.9-7.6) versus 7.5 months (95% CI 5.1-11.3) in \"older-old\" patients (P = .69) whilst respective OS was 12.3 (95% CI 10.1-15.5) and 10.4 months (95% CI 9.0-14.6) (P = .0816). Toxicity prompted chemotherapy cessation in 17 (15%) \"young-old\" and 3 (13%) \"older-old\" patients (P = .97). Multivariate analysis identified CCI and ECOG performance status as predictive for PFS and OS, respectively. No causative relationship was identified with other variables.
CONCLUSIONS: Our study of real-world older-adults show that significant number of \"older-old\" patients with GEC do not receive chemotherapy. Among \"older-old\" adults who do receive systemic therapy, outcomes are comparable; this underscores the importance of geriatric assessment-guided care and suggests that age alone should not be a barrier to receipt of chemotherapy in patients with advanced GEC.
METHODS: A retrospective analysis identified patients aged 65-74 (young-old) and ≥75 years (older-old) diagnosed with advanced GEC. Patient and tumor characteristics were recorded, with descriptive analysis, time-to-event data analysis using Kaplan-Meier curves and multivariate Cox proportional hazards regression analysis performed.
RESULTS: One hundred and ninety-eight \"young-old\" and 109 \'older-old\' patients were identified. Patient characteristics were similar between groups except for Charlson Co-morbidity Index (CCI), with lower co-morbidities in the \"young-old\" compared to \"older-old\" cohort (P < .001; CCI = 0 in 103 (52%) \"young-old\" vs 31 (28%) \"older-old\"). The primary diagnosis in both groups was adenocarcinoma. 119 (60%) \"young-old\" and 25 (23%) \"older-old\" patients received chemotherapy (P < .001). Performance status was the primary explanation for chemotherapy non-receipt in both cohorts; age was the explanation in 21 (25%) \"older-old\" patients and none in the \"young-old\" patients. PFS for first-line systemic therapy in \"young-old\" patients was 6.4 (95% CI 5.9-7.6) versus 7.5 months (95% CI 5.1-11.3) in \"older-old\" patients (P = .69) whilst respective OS was 12.3 (95% CI 10.1-15.5) and 10.4 months (95% CI 9.0-14.6) (P = .0816). Toxicity prompted chemotherapy cessation in 17 (15%) \"young-old\" and 3 (13%) \"older-old\" patients (P = .97). Multivariate analysis identified CCI and ECOG performance status as predictive for PFS and OS, respectively. No causative relationship was identified with other variables.
CONCLUSIONS: Our study of real-world older-adults show that significant number of \"older-old\" patients with GEC do not receive chemotherapy. Among \"older-old\" adults who do receive systemic therapy, outcomes are comparable; this underscores the importance of geriatric assessment-guided care and suggests that age alone should not be a barrier to receipt of chemotherapy in patients with advanced GEC.
摘要：
背景：老年患者食管癌和胃癌（GEC）的发病率正在增加，然而,75岁以上的患者在临床试验中的代表性一直偏低.我们试图研究老年人姑息性化疗给药模式和生存结局。
方法：回顾性分析确定了年龄在65-74岁（年轻人）和年龄≥75岁（老年人）被诊断为晚期GEC的患者。记录患者和肿瘤特征，通过描述性分析，使用Kaplan-Meier曲线和多变量Cox比例风险回归分析进行的事件发生时间数据分析.
结果：确定了一百九十八名“年轻人”和109名“老年人”。除Charlson合并症指数（CCI）外，两组之间的患者特征相似，与“年老”队列相比，“年老”队列中的合并症较低(P<.001；CCI=0/103(52%)“年老”vs31(28%)“年老”)。两组的主要诊断均为腺癌。119例（60%）“青年”和25例（23%）“老年”患者接受化疗（P<.001）。表现状况是两个队列中未接受化疗的主要解释；年龄是21名（25％）“老年”患者的解释，而“年轻”患者则没有。“年轻老年”患者一线全身治疗的PFS为6.4（95％CI5.9-7.6），而“老年”患者为7.5个月（95％CI5.1-11.3）（P=.69），而各自的OS分别为12.3（95％CI10.1-15.5）和10.4个月（95％CI9.0-14.6）（P=.0816）。毒性促使17例（15％）“年轻人”和3例（13％）“老年人”患者停止化疗（P=0.97）。多变量分析确定CCI和ECOG性能状态可预测PFS和OS，分别。未发现与其他变量的因果关系。
结论：我们对真实世界老年人的研究表明，相当数量的“老年”GEC患者没有接受化疗。在接受系统治疗的“老年”成年人中，结果具有可比性;这强调了老年评估指导护理的重要性,并提示在晚期GEC患者中,仅年龄不应成为接受化疗的障碍.
方法：回顾性分析确定了年龄在65-74岁（年轻人）和年龄≥75岁（老年人）被诊断为晚期GEC的患者。记录患者和肿瘤特征，通过描述性分析，使用Kaplan-Meier曲线和多变量Cox比例风险回归分析进行的事件发生时间数据分析.
结果：确定了一百九十八名“年轻人”和109名“老年人”。除Charlson合并症指数（CCI）外，两组之间的患者特征相似，与“年老”队列相比，“年老”队列中的合并症较低(P<.001；CCI=0/103(52%)“年老”vs31(28%)“年老”)。两组的主要诊断均为腺癌。119例（60%）“青年”和25例（23%）“老年”患者接受化疗（P<.001）。表现状况是两个队列中未接受化疗的主要解释；年龄是21名（25％）“老年”患者的解释，而“年轻”患者则没有。“年轻老年”患者一线全身治疗的PFS为6.4（95％CI5.9-7.6），而“老年”患者为7.5个月（95％CI5.1-11.3）（P=.69），而各自的OS分别为12.3（95％CI10.1-15.5）和10.4个月（95％CI9.0-14.6）（P=.0816）。毒性促使17例（15％）“年轻人”和3例（13％）“老年人”患者停止化疗（P=0.97）。多变量分析确定CCI和ECOG性能状态可预测PFS和OS，分别。未发现与其他变量的因果关系。
结论：我们对真实世界老年人的研究表明，相当数量的“老年”GEC患者没有接受化疗。在接受系统治疗的“老年”成年人中，结果具有可比性;这强调了老年评估指导护理的重要性,并提示在晚期GEC患者中,仅年龄不应成为接受化疗的障碍.
