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Background <p>Endoscopic resection (ER) is the standard treatment for superficial esophageal squamous cell carcinoma (ESCC). However, in patients aged ≥ 80 years, ER has limited long-term benefits owing to the higher mortality risk from other diseases. We assessed the therapeutic outcomes and prognostic predictors of ER in patients with ESCC aged ≥ 80 years at three institutions.</p> Methods <p>Patient characteristics and overall survival (OS) were evaluated using Cox proportional hazards regression models.</p> Results <p>This study included 161 patients with 161 lesions. The median patient age was 82 years. Patient characteristics included a median Brinkman Index (BI) of 570, Eastern Cooperative Oncology Group Performance Status (ECOG-PS) class 0–1 in 150 patients (93.2%), median Charlson Comorbidity Index (CCI) of 2, and high-sensitivity modified Glasgow Prognostic Score (HS-mGPS) class 0 in 122 patients (75.8%). Procedure-related outcomes revealed that 122 patients (75.8%) underwent curative resection, with no treatment-related deaths. Fifty-five patients (34.2%) died, including two from ESCC. The 5-year OS rate was 71.2%. BI ≥ 570 (hazard ratio [HR], 2.37; 95% confidence interval [CI], 1.07–5.25; <i>P</i> = 0.034), ECOG-PS 2–3 (HR, 3.25; 95% CI, 1.29–8.19; <i>P</i> = 0.012), CCI ≥ 3 (HR, 2.49; 95% CI, 1.37–4.53; <i>P</i> = 0.003), and HS-mGPS ≥ 1 (HR, 2.07; 95% CI, 1.03–4.19; <i>P</i> = 0.042) were identified as poor prognostic predictors, with 5-year OS rates of 63.2, 28.3, 56.9, and 52.3%, respectively. The 5-year OS rate was 19.0% (95% CI, 0.9–55.6) among patients with both BI ≥ 570 and ECOG-PS 2–3, and combinations of ECOG-PS 2–3 with other predictors were associated with lower OS.</p> Conclusions <p>Higher BI, ECOG-PS, CCI, and HS-mGPS scores were independent predictors of poor prognosis. In patients with multiple predictors, particularly those involving higher ECOG-PS, observation without ER may be considered as a treatment option after a thorough discussion with the patient.</p>

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Therapeutic outcomes and prognostic predictors of endoscopic resection for esophageal squamous cell carcinoma in patients aged ≥ 80 years: a multicenter retrospective study

  • 期刊论文

  • 发表日期：

    2026年5月14日

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  • Wataru Kurihara,
  • Yusuke Horiuchi,
  • Yasunori Yamamoto,
  • Shogo Kitahata,
  • Junki Tokura,
  • Naoki Miyazaki,
  • Masanori Abe,
  • Yoshio Ikeda,
  • Yoichi Hiasa,
  • Junko Fujisaki

摘要

Background

Endoscopic resection (ER) is the standard treatment for superficial esophageal squamous cell carcinoma (ESCC). However, in patients aged ≥ 80 years, ER has limited long-term benefits owing to the higher mortality risk from other diseases. We assessed the therapeutic outcomes and prognostic predictors of ER in patients with ESCC aged ≥ 80 years at three institutions.

Methods

Patient characteristics and overall survival (OS) were evaluated using Cox proportional hazards regression models.

Results

This study included 161 patients with 161 lesions. The median patient age was 82 years. Patient characteristics included a median Brinkman Index (BI) of 570, Eastern Cooperative Oncology Group Performance Status (ECOG-PS) class 0–1 in 150 patients (93.2%), median Charlson Comorbidity Index (CCI) of 2, and high-sensitivity modified Glasgow Prognostic Score (HS-mGPS) class 0 in 122 patients (75.8%). Procedure-related outcomes revealed that 122 patients (75.8%) underwent curative resection, with no treatment-related deaths. Fifty-five patients (34.2%) died, including two from ESCC. The 5-year OS rate was 71.2%. BI ≥ 570 (hazard ratio [HR], 2.37; 95% confidence interval [CI], 1.07–5.25; P = 0.034), ECOG-PS 2–3 (HR, 3.25; 95% CI, 1.29–8.19; P = 0.012), CCI ≥ 3 (HR, 2.49; 95% CI, 1.37–4.53; P = 0.003), and HS-mGPS ≥ 1 (HR, 2.07; 95% CI, 1.03–4.19; P = 0.042) were identified as poor prognostic predictors, with 5-year OS rates of 63.2, 28.3, 56.9, and 52.3%, respectively. The 5-year OS rate was 19.0% (95% CI, 0.9–55.6) among patients with both BI ≥ 570 and ECOG-PS 2–3, and combinations of ECOG-PS 2–3 with other predictors were associated with lower OS.

Conclusions

Higher BI, ECOG-PS, CCI, and HS-mGPS scores were independent predictors of poor prognosis. In patients with multiple predictors, particularly those involving higher ECOG-PS, observation without ER may be considered as a treatment option after a thorough discussion with the patient.