Worni M, Castleberry A W, Gloor B, Pietrobon R, Haney J C, D'Amico T A, Akushevich I, Berry M F
Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA; Department of Visceral Surgery and Medicine, University of Bern, Bern, Switzerland.
Dis Esophagus. 2014 Sep-Oct;27(7):662-9. doi: 10.1111/dote.12123. Epub 2013 Aug 13.
We examined outcomes and trends in surgery and radiation use for patients with locally advanced esophageal cancer, for whom optimal treatment isn't clear. Trends in surgery and radiation for patients with T1-T3N1M0 squamous cell or adenocarcinoma of the mid or distal esophagus in the Surveillance, Epidemiology, and End Results database from 1998 to 2008 were analyzed using generalized linear models including year as predictor; Surveillance, Epidemiology, and End Results doesn't record chemotherapy data. Local treatment was unimodal if patients had only surgery or radiation and bimodal if they had both. Five-year cancer-specific survival (CSS) and overall survival (OS) were analyzed using propensity-score adjusted Cox proportional-hazard models. Overall 5-year survival for the 3295 patients identified (mean age 65.1 years, standard deviation 11.0) was 18.9% (95% confidence interval: 17.3-20.7). Local treatment was bimodal for 1274 (38.7%) and unimodal for 2021 (61.3%) patients; 1325 (40.2%) had radiation alone and 696 (21.1%) underwent only surgery. The use of bimodal therapy (32.8-42.5%, P = 0.01) and radiation alone (29.3-44.5%, P < 0.001) increased significantly from 1998 to 2008. Bimodal therapy predicted improved CSS (hazard ratios [HR]: 0.68, P < 0.001) and OS (HR: 0.58, P < 0.001) compared with unimodal therapy. For the first 7 months (before survival curve crossing), CSS after radiation therapy alone was similar to surgery alone (HR: 0.86, P = 0.12) while OS was worse for surgery only (HR: 0.70, P = 0.001). However, worse CSS (HR: 1.43, P < 0.001) and OS (HR: 1.46, P < 0.001) after that initial timeframe were found for radiation therapy only. The use of radiation to treat locally advanced mid and distal esophageal cancers increased from 1998 to 2008. Survival was best when both surgery and radiation were used.
我们研究了局部晚期食管癌患者手术及放疗应用的结局和趋势，此类患者的最佳治疗方案尚不明晰。利用包含年份作为预测变量的广义线性模型，分析了1998年至2008年监测、流行病学及最终结果数据库中T1-T3N1M0期食管中下段鳞状细胞癌或腺癌患者的手术及放疗趋势；监测、流行病学及最终结果数据库未记录化疗数据。若患者仅接受手术或放疗，则局部治疗为单模式；若二者皆有，则为双模式。采用倾向评分调整的Cox比例风险模型分析5年癌症特异性生存率（CSS）和总生存率（OS）。所确定的3295例患者（平均年龄65.1岁，标准差11.0）的总体5年生存率为18.9%（95%置信区间：17.3 - 20.7）。1274例（38.7%）患者的局部治疗为双模式，2021例（61.3%）为单模式；1325例（40.2%）仅接受放疗，696例（21.1%）仅接受手术。从1998年到2008年，双模式治疗（32.8 - 42.5%，P = 0.01）和单纯放疗（29.3 - 44.5%，P < 0.001）的应用显著增加。与单模式治疗相比，双模式治疗可改善CSS（风险比[HR]：0.68，P < 0.001）和OS（HR：0.58，P < 0.001）。在最初7个月（生存曲线交叉之前），单纯放疗后的CSS与单纯手术相似（HR：0.86，P = 0.12），而单纯手术的OS更差（HR：0.70，P = 0.001）。然而，在该初始时间段之后，仅放疗的CSS（HR：1.43，P < 0.001）和OS（HR：1.46，P < 0.001）更差。从1998年到2008年，放疗在局部晚期食管中下段癌治疗中的应用增加。手术和放疗联合应用时生存率最佳。
