Chang Daniel T, Chapman Christopher, Shen John, Su Zheng, Koong Albert C
Department of Radiation Oncology at Stanford University Medical Center, 875 BlakeWilbur Drive, Stanford, CA 94305-5847, USA.
Am J Clin Oncol. 2009 Aug;32(4):405-10. doi: 10.1097/COC.0b013e3181917158.
The majority of esophageal cancer is either adenocarcinoma (ACA) or squamous cell carcinoma (SCCA). Recent randomized trials suggest that definitive chemoradiotherapy may be equally effective as surgery. However, the responsiveness of ACA versus SCCA to radiotherapy (RT) has never been compared. This Surveillance Epidemiology and End Results registry analysis investigates whether survival differed between ACA and SCCA based on the treatment modality.
Patients with T2-4N0 or N+ SCCA and ACA in the cervical or thoracic esophagus diagnosed from 1983 to 2004 were obtained from the Surveillance Epidemiology and End Results database. Patients with multiple primary cancers, underwent a surgical procedure other than partial or total esophagectomy, had metastatic or T1N0 disease, or received RT that did not include external beam radiation were excluded. Patients were grouped according to treatment received: RT alone, preoperative RT, any surgery (regardless of use of RT), and surgery alone.
A total of 4752 patients were included, 2680 (56%) had ACA and 2072 (44%) had SCCA. After adjusting for age, marital status, cost of living, and race, the overall survival (OS) and cause-specific survival was similar for all treatment groups except the RT-alone group where OS and SCC were superior for ACA. However, no difference in 3- and 5-year OS and cause-specific survival rates for all groups.
No difference in survival was seen between patients with ACA and SCCA across any of the major treatment modalities for esophageal cancer, suggesting that both histologies respond to treatment similarly.
大多数食管癌为腺癌（ACA）或鳞状细胞癌（SCCA）。近期的随机试验表明，根治性放化疗可能与手术同样有效。然而，从未比较过ACA与SCCA对放疗（RT）的反应性。这项监测、流行病学与最终结果登记分析研究了基于治疗方式的ACA和SCCA患者生存率是否存在差异。
从监测、流行病学与最终结果数据库中获取1983年至2004年诊断为颈段或胸段食管T2 - 4N0或N + SCCA和ACA的患者。排除患有多种原发性癌症、接受过部分或全食管切除术以外的手术、患有转移性或T1N0疾病或接受过不包括外照射的放疗的患者。根据接受的治疗将患者分组：单纯放疗、术前放疗、任何手术（无论是否使用放疗）和单纯手术。
共纳入4752例患者，2680例（56%）为ACA，2072例（44%）为SCCA。在调整年龄、婚姻状况、生活成本和种族后，除单纯放疗组（ACA的总生存期（OS）和特定病因生存期较好）外，所有治疗组的总生存期和特定病因生存期相似。然而，所有组的3年和5年总生存期及特定病因生存率无差异。
在食管癌的任何主要治疗方式中，ACA和SCCA患者的生存率均无差异，这表明两种组织学类型对治疗的反应相似。
