Age and CIRS-G for risk stratification in elderly esophageal squamous cell carcinoma patients receiving definitive chemoradiotherapy

Abstract

Objective To identify prognostic factors in elderly squamous cell carcinoma (ESCC) patients receiving definitive chemoradiotherapy (dCRT) and construct a prognostic risk stratification model for identifying high-risk subgroups among elderly patients. Methods ESCC patients aged ≥ge years receiving dCRT were enrolled. Baseline Cumulative Illness Rating Scale-Geriatrics (CIRS-G), Geriatric Nutrition Risk Index (GNRI), Systemic Immune-Inflammation Index (SII), clinical characteristics and adverse events were collected. Cox regression identified independent prognostic factors, with proportional hazards assessed by Schoenfeld residual tests and 95% confidence intervals validated by 1000 bootstrap resamples. Restricted cubic spline (RCS) curves evaluated potential cutoff values. Survival was analyzed by Kaplan-Meier method and compared by log-rank test. Results 88 patients were enrolled. Multivariate analysis identified age (HR 1.047, 95% CI 1.000–1.095) and CIRS-G (HR 1.179, 95% CI 1.014–1.376) as independent predictors of OS, whereas GNRI (HR 0.964, 95% CI 0.932–0.995) independently predicted PFS. Schoenfeld tests confirmed proportional hazards (all P > 0.05), with bootstrap resampling supporting coefficient stability. Cutoffs were set at 75 years for age, 7 for CIRS-G, and 98 for GNRI. A prognostic score combining age and CIRS-G stratified patients into low-risk (0–1) and high-risk (2) groups, with high-risk patients showing significantly inferior OS. GNRI ≥98 correlated with prolonged PFS versus <98. The high-risk group had higher neutropenia/leukopenia (15.0% vs. 6.3%) and pneumonitis (5.0% vs. 2.1%), with exclusive thrombocytopenia/anemia (2.5% each). Conclusions A composite risk score (age ≥75 years plus CIRS-G ≥7) identified a high-risk subgroup with poor OS. The optimal therapeutic strategy for this subgroup warrants prospective interventional trials.