Determinants in decision making for curative treatment and survival in patients with resectable oesophageal cancer in the Netherlands: A population-based study

M. Koëter, L.N. van Steenbergen, V.E.P.P. Lemmens, H.J.T. Rutten, J.A. Roukema, G.A.P. Nieuwenhuijzen

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Background
Preferred treatment for resectable oesophageal cancer is surgery with or without neoadjuvant treatment. However, oesophageal surgery has high morbidity and in vulnerable patients with co-morbidity other treatment modalities can be proposed. We examined determinants in decision making for surgery and factors affecting survival in patients with resectable oesophageal cancer in southern Netherlands.
Methods
All patients with resectable (T1-3, N0-1, M0-1A) oesophageal cancer (n = 849) diagnosed between 2003 and 2010 were selected from the population-based data of the Eindhoven Cancer Registry. Logistic regression analysis and multivariable Cox survival analysis were conducted to examine determinants of surgery and survival.
Results
Forty-five percent of the patients underwent surgery. In multivariable survival analysis only surgery, chemoradiation alone and tumour stage influenced overall survival (OS).
Patients aged ≥70 yrs, a low socioeconomic status (SES), one or more co-morbidities, cT1-tumours, cN1-tumours, a squamous-cell carcinoma, and those with a proximal tumour were significantly less often offered surgical resection.
Older patients and patients with cT1 tumours were less likely to receive chemoradiation alone. Patients with clinically positive lymph nodes or a proximal tumour were more likely to receive chemoradiation alone.
Conclusion
Treatment modalities including surgery and chemoradiation alone as well as stage of disease were independent predictors of a better OS in patients with potentially resectable oesophageal cancer. Therefore, the decision to perform potentially curative treatment is of crucial importance to improve OS for patients with potentially resectable oesophageal cancer. Although age and SES had no significant influence on overall survival, a higher age and low SES negatively influenced the probability to propose potentially curative treatment.
Keywords: Oesophageal cancer, Curative surgery, Survival, Population-based study
Original languageEnglish
Pages (from-to)863–869
JournalCancer Epidemiology
Volume39
Issue number6
DOIs
Publication statusPublished - 2015

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Esophageal Neoplasms
Netherlands
Neoplasms
Survival Analysis
Neoadjuvant Therapy
Logistic Models
Lymph Nodes

Cite this

Koëter, M. ; van Steenbergen, L.N. ; Lemmens, V.E.P.P. ; Rutten, H.J.T. ; Roukema, J.A. ; Nieuwenhuijzen, G.A.P. / Determinants in decision making for curative treatment and survival in patients with resectable oesophageal cancer in the Netherlands : A population-based study. In: Cancer Epidemiology. 2015 ; Vol. 39, No. 6. pp. 863–869.
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title = "Determinants in decision making for curative treatment and survival in patients with resectable oesophageal cancer in the Netherlands: A population-based study",
abstract = "BackgroundPreferred treatment for resectable oesophageal cancer is surgery with or without neoadjuvant treatment. However, oesophageal surgery has high morbidity and in vulnerable patients with co-morbidity other treatment modalities can be proposed. We examined determinants in decision making for surgery and factors affecting survival in patients with resectable oesophageal cancer in southern Netherlands.MethodsAll patients with resectable (T1-3, N0-1, M0-1A) oesophageal cancer (n = 849) diagnosed between 2003 and 2010 were selected from the population-based data of the Eindhoven Cancer Registry. Logistic regression analysis and multivariable Cox survival analysis were conducted to examine determinants of surgery and survival.ResultsForty-five percent of the patients underwent surgery. In multivariable survival analysis only surgery, chemoradiation alone and tumour stage influenced overall survival (OS).Patients aged ≥70 yrs, a low socioeconomic status (SES), one or more co-morbidities, cT1-tumours, cN1-tumours, a squamous-cell carcinoma, and those with a proximal tumour were significantly less often offered surgical resection.Older patients and patients with cT1 tumours were less likely to receive chemoradiation alone. Patients with clinically positive lymph nodes or a proximal tumour were more likely to receive chemoradiation alone.ConclusionTreatment modalities including surgery and chemoradiation alone as well as stage of disease were independent predictors of a better OS in patients with potentially resectable oesophageal cancer. Therefore, the decision to perform potentially curative treatment is of crucial importance to improve OS for patients with potentially resectable oesophageal cancer. Although age and SES had no significant influence on overall survival, a higher age and low SES negatively influenced the probability to propose potentially curative treatment.Keywords: Oesophageal cancer, Curative surgery, Survival, Population-based study",
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Determinants in decision making for curative treatment and survival in patients with resectable oesophageal cancer in the Netherlands : A population-based study. / Koëter, M.; van Steenbergen, L.N.; Lemmens, V.E.P.P.; Rutten, H.J.T.; Roukema, J.A.; Nieuwenhuijzen, G.A.P.

In: Cancer Epidemiology, Vol. 39, No. 6, 2015, p. 863–869.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Determinants in decision making for curative treatment and survival in patients with resectable oesophageal cancer in the Netherlands

T2 - A population-based study

AU - Koëter, M.

AU - van Steenbergen, L.N.

AU - Lemmens, V.E.P.P.

AU - Rutten, H.J.T.

AU - Roukema, J.A.

AU - Nieuwenhuijzen, G.A.P.

N1 - Geen affiliatie met TiU

PY - 2015

Y1 - 2015

N2 - BackgroundPreferred treatment for resectable oesophageal cancer is surgery with or without neoadjuvant treatment. However, oesophageal surgery has high morbidity and in vulnerable patients with co-morbidity other treatment modalities can be proposed. We examined determinants in decision making for surgery and factors affecting survival in patients with resectable oesophageal cancer in southern Netherlands.MethodsAll patients with resectable (T1-3, N0-1, M0-1A) oesophageal cancer (n = 849) diagnosed between 2003 and 2010 were selected from the population-based data of the Eindhoven Cancer Registry. Logistic regression analysis and multivariable Cox survival analysis were conducted to examine determinants of surgery and survival.ResultsForty-five percent of the patients underwent surgery. In multivariable survival analysis only surgery, chemoradiation alone and tumour stage influenced overall survival (OS).Patients aged ≥70 yrs, a low socioeconomic status (SES), one or more co-morbidities, cT1-tumours, cN1-tumours, a squamous-cell carcinoma, and those with a proximal tumour were significantly less often offered surgical resection.Older patients and patients with cT1 tumours were less likely to receive chemoradiation alone. Patients with clinically positive lymph nodes or a proximal tumour were more likely to receive chemoradiation alone.ConclusionTreatment modalities including surgery and chemoradiation alone as well as stage of disease were independent predictors of a better OS in patients with potentially resectable oesophageal cancer. Therefore, the decision to perform potentially curative treatment is of crucial importance to improve OS for patients with potentially resectable oesophageal cancer. Although age and SES had no significant influence on overall survival, a higher age and low SES negatively influenced the probability to propose potentially curative treatment.Keywords: Oesophageal cancer, Curative surgery, Survival, Population-based study

AB - BackgroundPreferred treatment for resectable oesophageal cancer is surgery with or without neoadjuvant treatment. However, oesophageal surgery has high morbidity and in vulnerable patients with co-morbidity other treatment modalities can be proposed. We examined determinants in decision making for surgery and factors affecting survival in patients with resectable oesophageal cancer in southern Netherlands.MethodsAll patients with resectable (T1-3, N0-1, M0-1A) oesophageal cancer (n = 849) diagnosed between 2003 and 2010 were selected from the population-based data of the Eindhoven Cancer Registry. Logistic regression analysis and multivariable Cox survival analysis were conducted to examine determinants of surgery and survival.ResultsForty-five percent of the patients underwent surgery. In multivariable survival analysis only surgery, chemoradiation alone and tumour stage influenced overall survival (OS).Patients aged ≥70 yrs, a low socioeconomic status (SES), one or more co-morbidities, cT1-tumours, cN1-tumours, a squamous-cell carcinoma, and those with a proximal tumour were significantly less often offered surgical resection.Older patients and patients with cT1 tumours were less likely to receive chemoradiation alone. Patients with clinically positive lymph nodes or a proximal tumour were more likely to receive chemoradiation alone.ConclusionTreatment modalities including surgery and chemoradiation alone as well as stage of disease were independent predictors of a better OS in patients with potentially resectable oesophageal cancer. Therefore, the decision to perform potentially curative treatment is of crucial importance to improve OS for patients with potentially resectable oesophageal cancer. Although age and SES had no significant influence on overall survival, a higher age and low SES negatively influenced the probability to propose potentially curative treatment.Keywords: Oesophageal cancer, Curative surgery, Survival, Population-based study

U2 - 10.1016/j.canep.2015.10.007

DO - 10.1016/j.canep.2015.10.007

M3 - Article

VL - 39

SP - 863

EP - 869

JO - Cancer Epidemiology

JF - Cancer Epidemiology

SN - 1877-7821

IS - 6

ER -