De B, Rhome R, Doucette J, Buckstein M
Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York City, USA.
Division of Biostatistics, Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York City, USA.
Dis Esophagus. 2017 Apr 1;30(4):1-10. doi: 10.1093/dote/dow037.
For cervical esophageal cancer (CEC), National Comprehensive Cancer Network guidelines support RT to 50-50.4 Gy with chemotherapy but acknowledge higher doses may be appropriate. This study uses the National Cancer Database (NCDB) to characterize RT practices and identify if a dose-response relationship exists for overall survival (OS) for definitive treatment of CEC. We queried the NCDB for patients diagnosed with Stage I-III CEC from 2004 to 2013, and selected patients receiving definitive RT with doses between 50 and 74 Gy. Using multivariate logistic regression, the database was analyzed to determine factors associated with use of RT > 50.4 Gy. Patients were then stratified into three dose categories. Predictors of OS were analyzed with univariate and multivariate methods using the Kaplan-Meier curves, the log-rank test, and the Cox proportional hazards analysis. We stratified 789 patients with CEC who were treated with definitive radiation ± chemotherapy: 50-50.4 Gy ('standard'), >50.4 and <66 Gy ('medium'), and 66-74 Gy ('high'). Of these patients, 215 (27%) received standard doses, 375 (48%) received medium doses, and 199 (25%) received high doses. Patients with Medicaid insurance and those with Stage II disease were less likely (P < 0.05) to receive >50.4 Gy. Sex, histology, distance to treatment facility, and academic/community facility type were not significantly associated with receipt of >50.4 Gy. There was no association between dose and OS for the medium or high groups when using univariate analysis or analysis adjusted for demographic, facility, and clinical attributes. Stage III disease and the Charlson-Deyo scores of 1 or 2 were associated with higher mortality (P < 0.05), while female sex and use of chemotherapy were associated with lower mortality (P < 0.01). Nearly three-fourths of CEC patients in the United States are treated with RT > 50.4 Gy. Higher radiation doses were not associated with increased OS in CEC patients in the NCDB.
对于颈段食管癌（CEC），美国国立综合癌症网络（National Comprehensive Cancer Network）指南支持采用50 - 50.4 Gy的放疗联合化疗，但也承认更高剂量可能是合适的。本研究利用国家癌症数据库（NCDB）来描述放疗实践，并确定在CEC的根治性治疗中总生存期（OS）是否存在剂量反应关系。我们查询了NCDB中2004年至2013年诊断为I - III期CEC的患者，并选择接受50至74 Gy剂量根治性放疗的患者。使用多因素逻辑回归分析数据库，以确定与使用>50.4 Gy放疗相关的因素。然后将患者分为三个剂量组。使用Kaplan - Meier曲线、对数秩检验和Cox比例风险分析，通过单因素和多因素方法分析OS的预测因素。我们将789例接受根治性放疗±化疗的CEC患者进行分层：50 - 50.4 Gy（“标准剂量”）、>50.4且<66 Gy（“中等剂量”）以及66 - 74 Gy（“高剂量”）。在这些患者中，215例（27%）接受标准剂量，375例（48%）接受中等剂量，199例（25%）接受高剂量。有医疗补助保险的患者和II期疾病患者接受>50.4 Gy放疗的可能性较小（P < 0.05）。性别、组织学类型、到治疗机构的距离以及学术/社区机构类型与接受>50.4 Gy放疗无显著相关性。在单因素分析或根据人口统计学、机构和临床特征进行调整的分析中，中等剂量组或高剂量组的剂量与OS之间均无关联。III期疾病和Charlson - Deyo评分为1或2与较高死亡率相关（P < 0.05），而女性性别和使用化疗与较低死亡率相关（P < 0.01）。在美国，近四分之三的CEC患者接受>50.4 Gy的放疗。在NCDB中，较高的放疗剂量与CEC患者的OS增加无关。
