在可切除的食管及食管胃交界腺癌中，新辅助放化疗与单纯化疗相比无生存差异：来自美国国立癌症数据库的结果

No Survival Difference with Neoadjuvant Chemoradiotherapy Compared with Chemotherapy in Resectable Esophageal and Gastroesophageal Junction Adenocarcinoma: Results from the National Cancer Data Base.

作者信息

Al-Sukhni Eisar, Gabriel Emmanuel, Attwood Kristopher, Kukar Moshim, Nurkin Steven J, Hochwald Steven N

机构信息

Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY.

Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY.

出版信息

J Am Coll Surg. 2016 Dec;223(6):784-792.e1. doi: 10.1016/j.jamcollsurg.2016.09.002. Epub 2016 Sep 15.

DOI:10.1016/j.jamcollsurg.2016.09.002

PMID:27641320

Abstract

BACKGROUND

Neoadjuvant treatment improves survival in resectable esophageal adenocarcinoma, but the optimal regimen has not been defined. Neoadjuvant chemoradiation (nCRT) is associated with higher pathologic complete response (pCR) relative to chemotherapy (nCTX), but has not been shown to improve survival; however, previous studies have been underpowered to demonstrate a survival difference. The objective of this study was to determine if nCRT is associated with increased survival relative to nCTX in patients with resectable esophageal adenocarcinoma.

STUDY DESIGN

The National Cancer Data Base (2006 to 2013) was retrospectively reviewed for patients with esophageal adenocarcinoma who underwent neoadjuvant treatment followed by resection. Data were collected regarding patient, disease, and treatment variables. Outcomes included 3- and 5-year overall survival (OS), pCR rate, and short-term postoperative outcomes. Propensity-adjusted analysis was conducted to account for baseline differences between treatment groups.

RESULTS

Six hundred fifty patients received nCTX and 6,336 received nCRT. Patients who underwent nCTX had slightly smaller tumors, and fewer were clinical stage III at baseline. Pathologic complete response was 17.2% with nCTX and 31.6% with nCRT (p < 0.001). Receiving nCRT was associated with fewer nodes examined, fewer nodes involved, fewer T3/4 tumors, and fewer positive margins than nCTX. There was no significant difference in OS between the 2 groups (hazard ratio [HR] 1.08 nCRT vs nCTX, 95% CI 0.95, 1.21, p = 0.228). There was no significant difference in short-term postoperative outcomes by treatment modality.

CONCLUSIONS

Neoadjuvant chemoradiation is not associated with improved survival relative to nCTX for resectable esophageal adenocarcinoma. Radiation may potentially be omitted in some patients with this disease.

摘要

背景

新辅助治疗可提高可切除食管腺癌患者的生存率，但最佳治疗方案尚未确定。相对于单纯化疗（nCTX），新辅助放化疗（nCRT）可使病理完全缓解（pCR）率更高，但尚未证明其能提高生存率；然而，既往研究的样本量不足以显示出生存差异。本研究的目的是确定在可切除食管腺癌患者中，nCRT相对于nCTX是否与生存率提高相关。

研究设计

对国家癌症数据库（2006年至2013年）进行回顾性分析，纳入接受新辅助治疗后行手术切除的食管腺癌患者。收集患者、疾病和治疗变量的数据。观察指标包括3年和5年总生存率（OS）、pCR率和术后短期转归。进行倾向调整分析以解释治疗组之间的基线差异。

结果

650例患者接受了nCTX，6336例接受了nCRT。接受nCTX的患者肿瘤略小，基线时临床分期为III期的患者较少。nCTX组的病理完全缓解率为17.2%，nCRT组为31.6%（p<0.001）。与nCTX相比，接受nCRT的患者检查的淋巴结数量更少、受累淋巴结更少、T3/4期肿瘤更少、切缘阳性更少。两组的OS无显著差异（风险比[HR]：nCRT组对比nCTX组为1.08，95%CI为0.95至1.21，p=0.228）。不同治疗方式的术后短期转归无显著差异。