A preliminary outcome analysis of the patterns of care study in Japan for esophageal cancer patients with special reference to age: Non surgery group

Background: The Patterns of Care Study (PCS) was imported to Japan from the United States in July 1996, A preliminary outcome analysis of the PCS for esophageal cancer patients in Japan was made with special reference to age, because the elderly population is rapidly increasing in Japan, Patients and Methods: From July 1996 to February 1998, external PCS audits were performed for 37 institutions nationwide and detailed information of 5 61 esophageal cancer patients treated during the period 1992-1994 was colle cted by using the fifth PCS data format developed in the United States. Thi s format was provided courtesy of the American College of Radiology, For th is study, patients who had not undergone surgery (n = 336) were selected. T he patients were classified into three age groups: < 65 years old (n = 119) , between 65 and 74 years (n = 93), and 75 Sears or older (n = 123), Cox's proportional hazards model was used for the statistical analysis, with surv ival, acute/subacute complication and late complication of grade 3 or more based on RTOG criteria, as the endpoints, Results: Significant prognostic factors for the entire non-surgery group we re Karnofsky Performance Status (KPS) (p = 0.0007), stage (p = 0.0001), and external irradiation dose (p = 0.0001). For the younger group, KPS (p = 0. 0004), stage (p = 0.0197), and utilization of brachytherapy (p = 0.0010) we re significant, while for the intermediate age group it was KPS (p = 0.0027 ), history of pulmonary disease (p = 0.0339), stage (p = 0.0001), and exter nal dose (p = 0.0001), and for the elderly group, stage (p = 0.0001) and ex ternal irradiation dose (p 0.0224) were significant. Significant risk facto rs for complications for the entire group were stage (p = 0.0411), external dose (p = 0.0163), and stratification of institution (academic vs. nonacad emic) (p = 0.0114), Significant risk factors for the younger group were his tory of pulmonary disease (p = 0.0495) and external dose (p = 0.0037), and the other age groups showed no significant risk factors. Conclusion: Age was not a significant prognostic or risk factor for esophag eal cancer patients in the non-surgery group treated with radiation therapy . Therefore, radiation therapy represented an important treatment modality for the elderly as well as for the younger esophageal cancer patients. Exte rnal dose was a treatment-related prognostic factor for the elderly as well as for the intermediate age group. (C) 2000 Elsevier Science Inc.