Liu ShiLiang, Qiu Bo, Luo GuangYu, Liang Ying, Zheng YuZhen, Chen ZhaoLin, Luo KongJia, Xi Mian, Liu Qing, Hu YongHong, Li Qun, Fu JianHua, Liu MengZhong, Yang Hong, Liu Hui
State Key Laboratory of Oncology in South China;; Guangdong Esophageal Cancer Research Institute, Guangzhou, Guangdong, P.R. China;; Department of Radiation Oncology.
State Key Laboratory of Oncology in South China;; Guangdong Esophageal Cancer Research Institute, Guangzhou, Guangdong, P.R. China;; Department of Endoscopy.
J Cancer. 2017 Feb 25;8(4):683-690. doi: 10.7150/jca.17048. eCollection 2017.
We used the TNM staging matched-pair approach to compare the efficacies of surgery after neoadjuvant chemoradiotherapy (NCT), surgery alone and definitive chemoradiotherapy (CCRT) in patients with localized advanced thoracic esophageal squamous cell carcinoma (ESCC). A total of 642 patients with ESCC from previous studies were studied. Patients whose treatment involved NCT + surgery and surgery alone were compared with patients receiving CCRT. Prospensity score matched-pair comparison based on pre-treatment TNM staging was developed to assess the efficacies of these treatment options. Prospensity score matched-pair comparison to control for bias generated a cohort of 274 patients who were eligible for comparison. The 3-year OS rate was 70.0% in the NCT + surgery group, compared to 51.7% in the surgery group (p=0.000) and 61.9% in the CCRT group (p=0.082). With the TNM staging matched-pair approach, the CCRT group had more upper thoracic ESCC patients (43/92, 46.7%), while the surgery group had more lower thoracic ESCC patients (37/92, 40.2%). The 3-year OS rates were comparable between the surgery alone group and CCRT group (p=0.109). NCT plus surgery was superior in OS to surgery alone or CCRT. The 3-year OS rates were comparable between the surgery alone group and CCRT group with TNM staging matched-pair approach. Further investigation is warranted to confirm these findings.
我们采用TNM分期匹配对方法，比较新辅助放化疗（NCT）后手术、单纯手术以及根治性放化疗（CCRT）对局部晚期胸段食管鳞状细胞癌（ESCC）患者的疗效。共研究了来自既往研究的642例ESCC患者。将接受NCT+手术和单纯手术治疗的患者与接受CCRT的患者进行比较。基于治疗前TNM分期进行倾向评分匹配对比较，以评估这些治疗方案的疗效。通过倾向评分匹配对比较来控制偏倚，产生了一组274例符合比较条件的患者。NCT+手术组的3年总生存率为70.0%，而手术组为51.7%（p=0.000），CCRT组为61.9%（p=0.082）。采用TNM分期匹配对方法时，CCRT组上胸段ESCC患者更多（43/92，46.7%），而手术组下胸段ESCC患者更多（37/92，40.2%）。单纯手术组和CCRT组的3年总生存率相当（p=0.109）。NCT联合手术在总生存率方面优于单纯手术或CCRT。采用TNM分期匹配对方法时，单纯手术组和CCRT组的3年总生存率相当。有必要进行进一步研究以证实这些发现。
