Shao Meng S, Wong Andrew T, Schwartz David, Weiner Joseph P, Schreiber David
Department of Radiation Oncology, State University of New York Downstate Medical Center, Brooklyn; and Department of Radiation Oncology, Brooklyn Campus of the Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York.
Department of Radiation Oncology, State University of New York Downstate Medical Center, Brooklyn; and Department of Radiation Oncology, Brooklyn Campus of the Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York.
Ann Thorac Surg. 2016 Jun;101(6):2148-54. doi: 10.1016/j.athoracsur.2015.12.056. Epub 2016 Mar 24.
The optimal management of patients with localized esophageal cancer is uncertain. The objective of this study was to analyze contemporary patterns of care for esophageal cancer using the National Cancer Database.
Patients diagnosed with localized esophageal adenocarcinoma or squamous cell carcinoma from 2004 to 2011 and who received preoperative chemoradiation therapy, followed by esophagectomy (trimodality), or definitive chemoradiation therapy were identified in the National Cancer Database. Only patients who received a radiation dose between 41.4 and 64.8 Gy were included. Kaplan-Meier, Cox regression, and propensity score-matched survival analyses were performed to compare overall survival between those receiving chemoradiation therapy vs trimodality therapy.
There were 8,064 patients, of whom 44.9% received trimodality therapy and 55.1% chemoradiation therapy. Trimodality therapy was associated with improved overall survival (p < 0.001), with a median overall survival of 35.6 months and 3-year overall survival of 49.6%, whereas for patients receiving chemoradiation therapy, median and 3-year overall survival were 16.8 months and 26.8%, respectively. For patients receiving chemoradiation therapy, dose escalation beyond 50.4 Gy was used 35.9% of the time but was not associated with an improvement in overall survival over those receiving 50 Gy (p = 0.62). The survival benefit of trimodality therapy remained after propensity score-matched analysis.
Definitive chemoradiation therapy is more commonly used than trimodality therapy, but trimodality treatment is associated with excellent survival outcomes on propensity-matched and unmatched survival analysis. Dose escalation beyond 50 Gy remains frequently used but is not associated with a survival benefit.
局部食管癌患者的最佳治疗方案尚不确定。本研究的目的是利用国家癌症数据库分析食管癌的当代治疗模式。
在国家癌症数据库中识别出2004年至2011年被诊断为局部食管腺癌或鳞状细胞癌且接受术前放化疗，随后行食管切除术（三联疗法）或根治性放化疗的患者。仅纳入接受41.4至64.8 Gy放射剂量的患者。进行Kaplan-Meier、Cox回归和倾向评分匹配生存分析，以比较接受放化疗与三联疗法患者的总生存期。
共有8064例患者，其中44.9%接受三联疗法，55.1%接受放化疗。三联疗法与总生存期改善相关（p<0.001），中位总生存期为35.6个月，3年总生存率为49.6%，而接受放化疗的患者中位总生存期和3年总生存率分别为16.8个月和26.8%。接受放化疗的患者中，35.9%的时间采用了超过50.4 Gy的剂量递增，但与接受50 Gy的患者相比，总生存期并无改善（p = 0.62）。倾向评分匹配分析后，三联疗法的生存获益依然存在。
根治性放化疗比三联疗法更常用，但在倾向匹配和未匹配的生存分析中，三联疗法均与优异的生存结果相关。超过50 Gy的剂量递增仍经常使用，但未带来生存获益。
