*Department of Radiation Oncology, Department of Veterans Affairs New York Harbor Healthcare System, Brooklyn, NY †Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY ‡Department of Radiation Oncology, UF Health Cancer Center-Orlando Health, Orlando, FL.
Ann Surg. 2017 Jun;265(6):1146-1151. doi: 10.1097/SLA.0000000000001825.
The objective of this study was to analyze the impact on overall survival (OS) from the addition of postoperative radiation with or without chemotherapy after esophagectomy, using a large, hospital-based dataset.
Previous retrospective studies have suggested an OS advantage for postoperative chemoradiation over surgery alone, although prospective data are lacking.
The National Cancer Data Base was queried to select patients diagnosed with stage pT3-4Nx-0M0 or pT1-4N1-3M0 esophageal carcinoma (squamous cell or adenocarcinoma) from 1998 to 2011 treated with definitive esophagectomy ± postoperative radiation and/or chemotherapy. OS was analyzed using the Kaplan-Meier method and compared using the log-rank test. Multivariate Cox regression analysis was used to identify covariates associated with OS.
There were 4893 patients selected, of whom 1153 (23.6%) received postoperative radiation. Most patients receiving radiation also received sequential/concomitant chemotherapy (89.9%). For the entire cohort, postoperative radiation was associated with a statistically significant but modest absolute improvement in survival (hazard ratio 0.77; 95% CI, 0.71-0.83; P < 0.001). On subgroup analysis, postoperative radiation was associated with improved OS for patients with node-positive disease (3-yr OS 34.3 % vs 27.8%, P < 0.001) or positive margins (3-yr OS 36.4% vs 18.0%, P < 0.001). When chemotherapy usage was incorporated, sequential chemotherapy was associated with the best survival (P < 0.001). Multivariate analysis revealed that the addition of chemotherapy to radiation therapy, whether sequentially or concurrently, was a strong prognostic factor for OS.
In this hospital-based study, the addition of postoperative chemoradiation (either sequentially or concomitantly) after esophagectomy was associated with improved OS for patients with node-positive disease or positive margins.
本研究旨在通过使用大型医院数据库分析食管癌术后放疗加或不加化疗对总生存期（OS）的影响。
先前的回顾性研究表明，术后放化疗联合手术比单纯手术具有生存优势，但缺乏前瞻性数据。
从 1998 年至 2011 年，国家癌症数据库中选择了经病理诊断为 T3-4Nx-0M0 或 T1-4N1-3M0 期食管鳞癌或腺癌（鳞癌或腺癌）并接受根治性食管切除术+术后放疗和/或化疗的患者。使用 Kaplan-Meier 方法分析 OS，并使用对数秩检验比较。多变量 Cox 回归分析用于确定与 OS 相关的协变量。
共选择了 4893 例患者，其中 1153 例（23.6%）接受了术后放疗。大多数接受放疗的患者也接受了序贯/同期化疗（89.9%）。对于整个队列，术后放疗与生存的统计学显著但适度的绝对改善相关（风险比 0.77；95%CI，0.71-0.83；P<0.001）。亚组分析显示，术后放疗与淋巴结阳性疾病（3 年 OS 34.3%比 27.8%，P<0.001）或阳性切缘（3 年 OS 36.4%比 18.0%，P<0.001）患者的 OS 改善相关。当纳入化疗使用情况时，序贯化疗与最佳生存相关（P<0.001）。多变量分析显示，化疗联合放疗，无论是序贯还是同步，都是 OS 的一个强有力的预后因素。
在这项基于医院的研究中，食管癌术后放疗加或不加化疗（序贯或同步）与淋巴结阳性疾病或阳性切缘患者的 OS 改善相关。
