University of Oulu

Kauppila, J.H., Mattsson, F. & Lagergren, J. Impact of Age on the Treatment and Survival in Esophagogastric Cancer. Ann Surg Oncol 30, 2716–2725 (2023).

Impact of age on the treatment and survival in esophagogastric cancer

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Author: Kauppila, Joonas H.1,2; Mattsson, Fredrik1; Lagergren, Jesper1,3
Organizations: 1Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
2Surgery Research Unit, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
3School of Cancer and Pharmaceutical Sciences, King’s College London, and Guy’s and St Thomas’ NHS Foundation Trust, London, England
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.2 MB)
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Language: English
Published: Springer Nature, 2023
Publish Date: 2023-11-07


Background: The age-specific risks of mortality for patients with esophagogastric cancer and their probability of surgical treatment are not well-known.

Methods: This population-based, nationwide cohort study included all patients with esophageal or gastric (esophagogastric) cancer in Sweden between 1990 and 2013, with follow-up evaluation throughout 2018. Age at diagnosis (exposure) was categorized into nine 5-year groups. The main outcome was 5-year all-cause mortality. The secondary outcomes were 90-day all-cause mortality, 5-year disease-specific mortality, 5-year disease-specific mortality excluding 90-day all-cause mortality, and non-operation. For mortality outcomes, Cox regression provided hazard ratios (HRs) with 95% confidence intervals (95% CIs) adjusted for confounders. For non-operation, logistic regression provided odds ratios (ORs) with 95% CIs.

Results: Among 28,725 patients, 11,207 (39.0%) underwent surgery. For those who underwent surgery, the HRs of 5-year all-cause mortality were stable before the ages of 65 to 69 years. After that, it gradually increased for patients 65 to 69 years old (HR, 1.13; 95% CI, 1.01–1.26), patients 75 to 79 years old (HR, 1.29; 95% CI, 1.56–1.44), and patients older than 85 years (HR, 1.84; 95% CI, 1.60–2.11) compared with those younger than 50 years. Analyses of age as a continuous variable, other mortality outcomes and stratification by comorbidity and tumor type showed similar results. The odds of non-operation increased for patients 75 to 79 years old (OR, 2.09 [95% CI, 1.84–2.94] for patients 80 to 84 years old and OR, 5.00 [95% CI, 4.31–5.78] for patients ≥85 years old or older), compared with those younger than 50 years.

Conclusion: Older age, starting from 65 years, is associated with worse survival after surgery for esophagogastric cancer, and from 75 years with lower odds of surgical treatment.

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Series: Annals of surgical oncology
ISSN: 1068-9265
ISSN-E: 1534-4681
ISSN-L: 1068-9265
Volume: 30
Issue: 5
Pages: 2716 - 2725
DOI: 10.1245/s10434-022-13052-4
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
Funding: This study was supported by grants to Jesper Lagergren from the Swedish Cancer Society and the Swedish Research Council. The study sponsors had no role in the study design; in the collection, analysis, and interpretation of data, in the writing of the report, or in the decision to submit the paper for publication. Open access funding provided by Karolinska Institute. This work was supported by Cancerfonden, Vetenskapsrådet.
Copyright information: Ó The Author(s) 2023. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit