Department of Radiation Oncology, Stanford University and Cancer Center, Stanford, CA, USA.
Ann Surg Oncol. 2013 Nov;20(12):3999-4007. doi: 10.1245/s10434-013-3072-9. Epub 2013 Jun 26.
The optimal combination and timing of therapy for esophageal cancer remains controversial. The Surveillance, Epidemiology, and End Results (SEER)-Medicare registry was used to assess neoadjuvant and adjuvant therapy.
Patients diagnosed with nonmetastatic T3+ or N1+ esophageal adenocarcinoma (ACA) or squamous cell carcinoma (SCC) from 1995 to 2002 who underwent surgical resection within 6 months of diagnosis were studied. Medicare data defined preoperative chemoradiotherapy (preCRT), preoperative radiotherapy (preRT), postoperative CRT (postCRT), chemotherapy and surgery (CT + S), and surgery alone.
Of 419 eligible patients, 126 received preCRT, 55 preRT, 40 postCRT, 29 CT + S, and 169 surgery alone. PreCRT yielded median overall survival (OS) of 37 months, greater than surgery alone (17 months, p = 0.002) and postCRT (17 months, p = 0.06). PreRT (20 months, p = 0.20), postCRT (p = 0.88), and CT + S (20 months, p = 0.42) were not associated with OS benefit versus surgery alone. For SCC, preCRT improved survival versus surgery alone (p = 0.01), with a trend for ACA (p = 0.07). ACA (22 months) had greater OS than SCC (17 months) (p = 0.03). ACA, younger age, and married status were associated with increased OS. Adjusting for these, preCRT had longer OS versus surgery alone (p = 0.02) and postCRT (p = 0.03). Chemotherapy agents and surgical approach did not affect OS.
In the SEER-Medicare cohort, preCRT significantly improved survival versus surgery alone and postCRT for locally advanced esophageal cancer, particularly for SCC. PreRT, postCRT, and CT + S were not associated with longer survival.
食管癌的最佳治疗联合和时机仍存在争议。本研究使用监测、流行病学和最终结果（SEER）-医疗保险登记处评估新辅助和辅助治疗。
研究纳入了 1995 年至 2002 年间诊断为非转移性 T3+或 N1+食管腺癌（ACA）或鳞状细胞癌（SCC）并在诊断后 6 个月内行手术切除的患者。医疗保险数据定义了术前放化疗（preCRT）、术前放疗（preRT）、术后放化疗（postCRT）、化疗和手术（CT+S）以及单纯手术。
在 419 名符合条件的患者中，126 名接受了 preCRT，55 名接受了 preRT，40 名接受了 postCRT，29 名接受了 CT+S，169 名接受了单纯手术。与单纯手术相比，preCRT 可显著延长总生存（OS）（37 个月 vs 17 个月，p=0.002）和 postCRT（17 个月，p=0.06）。preRT（20 个月，p=0.20）、postCRT（p=0.88）和 CT+S（20 个月，p=0.42）与单纯手术相比，均不能改善 OS。对于 SCC，preCRT 可改善 OS（p=0.01），但对于 ACA 有改善趋势（p=0.07）。ACA（22 个月）的 OS 优于 SCC（17 个月）（p=0.03）。ACA、年龄较轻和已婚状态与 OS 延长相关。在调整这些因素后，与单纯手术相比，preCRT 可显著延长 OS（p=0.02）和 postCRT（p=0.03）。化疗药物和手术方法并不影响 OS。
在 SEER-医疗保险队列中，与单纯手术相比，preCRT 显著改善了局部晚期食管癌的生存，尤其是 SCC。preRT、postCRT 和 CT+S 与更长的生存时间无关。
