Division of Thoracic Surgery, Department of Surgery, Taipei-Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan.
J Thorac Cardiovasc Surg. 2017 Aug;154(2):732-740.e2. doi: 10.1016/j.jtcvs.2017.03.038. Epub 2017 Mar 21.
Although preoperative chemoradiation followed by surgery has been recognized as an efficient strategy for esophageal cancer treatments, several studies demonstrate survival benefits of postoperative chemoradiation for those undergoing upfront resection. The optimal sequence of surgery and chemoradiation remains unclear.
Data of 1647 patients with clinical stage II/III esophageal squamous cell carcinoma (ESCC), including 1245 receiving preoperative chemoradiation followed by esophagectomy (pre-OP CRT group) and 402 receiving primary esophagectomy followed postoperative chemoradiation (post-OP CRT group), were obtained from a nationwide database. Propensity score matching identified 286 well-balanced pairs for outcome comparison.
In matched patients, the 3-year overall survival (OS) rates/median survival were not significantly different between the 2 groups (44.0% 3-year OS/26.0 months; 95% confidence interval [CI], 18.9-89 38.0 months) in the pre-OP CRT group, versus 37.9% 3-year OS/23.5 months (95% CI, 18.5-29.9 months) in the post-OP CRT group, P = .3152). The 3-year disease-free survival rates (DFS)/median survival after surgery were 38.7% 3-year DFS/16.7 months (95% CI, 11.9-29.6 months) in the pre-OP CRT group, compared with 30.2% 3-year DFS/10.4 months (95% CI, 7.6-14.0 months) in the post-OP CRT group (P = .0674). In patients who had complete resection, the freedom from recurrence rate at 1 year after surgery was 74.8% and 67.6% in pre-OP CRT and post-OP CRT groups, respectively (P = .2696). In the multivariable analysis, treatment modality (pre- or post-OP CRT) was not a significant factor for OS (P = .258) or disease-free survival (P = .521).
Similar outcome can be achieved with postoperative chemoradiotherapy compared with preoperative chemoradiotherapy in patients with locally advanced ESCC. There is little difference between these 2 strategies.
尽管术前放化疗联合手术已被认为是治疗食管癌的有效策略，但多项研究表明对于接受根治性切除的患者，术后放化疗可带来生存获益。手术和放化疗的最佳顺序仍不明确。
本研究从全国性数据库中获取了 1647 例临床 II/III 期食管鳞癌（ESCC）患者的数据，其中 1245 例接受术前放化疗联合食管癌切除术（术前放化疗组），402 例接受根治性手术联合术后放化疗（术后放化疗组）。采用倾向评分匹配法对 286 对匹配良好的患者进行了结局比较。
在匹配患者中，两组的 3 年总生存率（OS）率/中位生存时间无显著差异（术前放化疗组为 44.0%的 3 年 OS/26.0 个月；95%置信区间[CI]：18.9-89.38.0 个月），而术后放化疗组为 37.9%的 3 年 OS/23.5 个月（95%CI：18.5-29.9 个月），P=0.3152。术前放化疗组的术后 3 年无病生存率（DFS）率/中位生存时间为 38.7%的 3 年 DFS/16.7 个月（95%CI：11.9-29.6 个月），而术后放化疗组为 30.2%的 3 年 DFS/10.4 个月（95%CI：7.6-14.0 个月），P=0.0674。在完全切除的患者中，术后 1 年无复发率分别为术前放化疗组的 74.8%和术后放化疗组的 67.6%（P=0.2696）。多变量分析显示，治疗方式（术前或术后放化疗）不是 OS（P=0.258）或无病生存（P=0.521）的显著因素。
对于局部晚期 ESCC 患者，术后放化疗与术前放化疗的疗效相当。这两种策略之间几乎没有差异。
