Yen Yu-Chun, Chang Jer-Hwa, Lin Wei-Cheng, Chiou Jeng-Fong, Chang Yin-Chun, Chang Chia-Lun, Hsu Han-Lin, Chow Jyh-Ming, Yuan Kevin Sheng-Po, Wu Alexander T H, Wu Szu-Yuan
Biostatistics Center and School of Public Health, Taipei Medical University, Taipei, Taiwan.
Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Cancer. 2017 Jun 1;123(11):2043-2053. doi: 10.1002/cncr.30565. Epub 2017 Feb 2.
Few large, prospective, randomized studies have investigated the effectiveness of esophagectomy in patients with thoracic esophageal squamous cell carcinoma (TESCC) who receive definitive radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) through modern, intensity modulated-RT (IMRT) techniques. The therapeutic effects of esophagectomy in patients with TESCC were evaluated using modern clinical staging and RT techniques and suitable RT doses.
The authors analyzed data from patients with TESCC from the Taiwan Cancer Registry database. Patients were categorized into the following groups on the basis of treatment modality to compare their outcomes: group 1 received definitive CCRT, group 2 received neoadjuvant RT followed by esophagectomy (total IMRT dose, ≥50 grays [Gy]), and group 3 receiving neoadjuvant CCRT followed by esophagectomy (total IMRT dose, ≥ 50 Gy). The median total RT dose and fraction size were 50.4 Gy and 1.8 Gy per fraction, respectively. Group 1 was used as the control arm for investigating the risk of mortality after treatment.
In total, 3123 patients who had TESCC without distant metastasis were enrolled. Patient ages 65 years and older, Charlson comorbidity index scores ≥3, advanced clinical stages (IIA-IIIC), alcohol consumption, and cigarette smoking were identified as significant, independent poor prognostic risk factors for overall survival in multivariate Cox regression analyses. In group 3, after adjustment for confounders, the adjusted hazard ratios (95% confidence intervals [CIs]) for overall mortality were 0.62 (95% CI, 0.41-0.93) for patients with clinical stage IIA disease, 0.61 (95% CI, 0.41-0.91) for those with clinical stage IIB disease, 0.47 (95% CI, 0.38-0.55) for those with clinical stage IIIA disease, 0.47 (95% CI, 0.39-0.56) for those with clinical stage IIIB disease, and 0.46 (95% CI, 0.37-0.57) for those with clinical stage IIIC disease.
Esophagectomy can be beneficial in patients with TESCC after definitive CCRT, especially in those who have advanced-stage disease. Cancer 2017;123:2043-2053. © 2017 American Cancer Society.
很少有大型前瞻性随机研究探讨过，对于接受根治性放疗（RT）或同步放化疗（CCRT）的胸段食管鳞状细胞癌（TESCC）患者，采用现代调强放疗（IMRT）技术进行食管切除的有效性。本研究采用现代临床分期和放疗技术以及合适的放疗剂量，评估TESCC患者接受食管切除的治疗效果。
作者分析了台湾癌症登记数据库中TESCC患者的数据。根据治疗方式将患者分为以下几组以比较其预后：第1组接受根治性CCRT，第2组接受新辅助放疗后行食管切除术（IMRT总剂量≥50格雷[Gy]），第3组接受新辅助CCRT后行食管切除术（IMRT总剂量≥50 Gy）。放疗总剂量中位数和分次剂量分别为50.4 Gy和每次1.8 Gy。第1组用作研究治疗后死亡风险的对照臂。
总共纳入了3123例无远处转移的TESCC患者。在多因素Cox回归分析中，年龄≥65岁、Charlson合并症指数评分≥3、临床分期晚期（IIA-IIIC期）、饮酒和吸烟被确定为总生存的显著独立不良预后危险因素。在第3组中，校正混杂因素后，临床IIA期患者的全因死亡校正风险比（95%置信区间[CI]）为0.62（95%CI，0.41-0.93），IIB期患者为0.61（95%CI，0.41-0.91），IIIA期患者为0.47（95%CI，0.38-0.55），IIIB期患者为0.47（95%CI，0.39-0.56），IIIC期患者为0.46（95%CI，0.37-0.57）。
对于接受根治性CCRT后的TESCC患者，食管切除术可能有益，尤其是对于晚期疾病患者。《癌症》2017年；123：2043-2053。©2017美国癌症协会。
