Department of Radiation Oncology, Cancer Center, Sun Yat-Sen University, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
J Thorac Oncol. 2017 Jun;12(6):1001-1010. doi: 10.1016/j.jtho.2017.03.017. Epub 2017 Mar 27.
The aim of this study was to identify patients with esophageal cancer who may benefit from induction chemotherapy (IC) before neoadjuvant chemoradiotherapy (nCRT) on the basis of a prognostic scoring model.
Between 1998 and 2015, 535 patients with esophageal cancer who underwent nCRT were included for analysis, including 218 patients who received IC before nCRT (IC group) and 317 patients who did not receive IC (non-IC group). A prognostic scoring model was developed to predict disease-free survival (DFS) on the basis of a Cox proportional hazards model.
The median follow-up time was 63.5 months (range 8.0-178.5) for survivors. The 5-year DFS rates were similar between the IC and non-IC groups (53.7% vs. 45.1%, p = 0.196). Multivariate analysis determined that histologic grade, tumor location, baseline positron emission tomography maximum standard uptake value, and lymph node size were independent prognostic factors for DFS. A prognostic scoring system was constructed by using these four factors, with the total score ranging from 0 to 6.2. When the median value was used as a cutoff, low-risk (≤3.5) and high-risk (>3.5) groups were identified. In the high-risk group, patients who received IC had a nonsignificantly higher pathologic complete response rate (p = 0.272) and a significantly better DFS (p = 0.03) than patients who did not receive IC. After propensity score matching, the high-risk group demonstrated a significantly improved DFS with IC, a benefit that was not observed in the low-risk group.
On the basis of the prognostic scoring model, the addition of IC to nCRT may provide a DFS benefit in high-risk patients with a risk score higher than 3.5. Prospective validation is warranted.
本研究旨在建立一个预后评分模型，以确定接受新辅助放化疗（nCRT）前诱导化疗（IC）可能获益的食管癌患者。
1998 年至 2015 年，535 例接受 nCRT 的食管癌患者纳入本研究，其中 218 例患者接受 IC（IC 组），317 例患者未接受 IC（非 IC 组）。通过 Cox 比例风险模型建立预后评分模型，预测无病生存（DFS）。
生存患者的中位随访时间为 63.5 个月（8.0-178.5）。IC 组和非 IC 组的 5 年 DFS 率分别为 53.7%和 45.1%（p=0.196）。多因素分析确定组织学分级、肿瘤位置、基线正电子发射断层扫描最大标准摄取值和淋巴结大小是 DFS 的独立预后因素。使用这四个因素构建了一个预后评分系统，总分为 0-6.2。当以中位数为界值时，分为低危（≤3.5）和高危（>3.5）组。在高危组中，接受 IC 的患者病理完全缓解率（p=0.272）虽无显著提高，但 DFS 显著改善（p=0.03）。经倾向评分匹配后，高危组患者接受 IC 后 DFS 显著改善，而低危组患者未观察到这一获益。
基于预后评分模型，对于风险评分高于 3.5 的高危患者，在 nCRT 基础上加用 IC 可能会带来 DFS 获益。需要前瞻性验证。
