Yamashita Hideomi, Seto Yasuyuki, Takenaka Ryousuke, Okuma Kae, Kiritooshi Tomoki, Mori Kazuhiko, Yamada Kazuhiko, Fukuda Takashi, Kaminishi Michio, Abe Osamu, Nakagawa Keiichi
Department of Radiology, University of Tokyo Hospital, Tokyo, Japan.
Department of Gastrointestinal Surgery, University of Tokyo Hospital, Tokyo, Japan.
PLoS One. 2017 May 9;12(5):e0177133. doi: 10.1371/journal.pone.0177133. eCollection 2017.
To compare radical surgery with definitive chemoradiation (CRT) for esophageal squamous cell carcinoma using propensity score (PS) matching at our single institution.
A total of 386 consecutive, surgically treated and 243 CRT-treated cases between 2001 and 2014 were analyzed. PS was calculated using multivariable analysis (logistic regression) for pairs of variables such as treatment time, age, sex, primary tumor location, clinical stage, and clinical T- and N-stage for patients after excluding clinical T4 and M1 cases. According to PS, 133 surgically-treated and 134 CRT-treated cases were selected randomly by software.
The patients' median age was 68 years in the CRT group and 71 years in the surgery group. Clinical stage II-III, T3, N0 (according to the 7th American Joint Committee on Cancer-2009), and upper plus middle thoracic esophageal disease were seen in 68%, 44%, 54%, and 59%, respectively, in the CRT group and 64%, 47%, 55%, and 64%, respectively, in the surgery group. The 3- and 5-year overall survival was 47.1% and 34.0% in the CRT group and 68.3% and 54.4% in the surgery group (p = 0.0019). The 3- and 5-year progression-free survival was 45.3% and 38.8% in the CRT group and 61.1% and 54.4% in the surgery group (p = 0.022).
CRT may be inferior to surgery in survival, although a selection bias for patients selected for a non-operative approach cannot be excluded, especially since surgery is the standard of care at this institution. A prospective randomized clinical trial will be necessary to draw a definite conclusion.
在我们的单一机构中，使用倾向评分（PS）匹配比较食管鳞状细胞癌的根治性手术与确定性放化疗（CRT）。
分析了2001年至2014年间连续接受手术治疗的386例和接受CRT治疗的243例病例。在排除临床T4和M1病例后，使用多变量分析（逻辑回归）对治疗时间、年龄、性别、原发肿瘤位置、临床分期以及临床T和N分期等变量对计算PS。根据PS，通过软件随机选择133例手术治疗病例和134例CRT治疗病例。
CRT组患者的中位年龄为68岁，手术组为71岁。CRT组中临床分期II - III期、T3、N0（根据2009年美国癌症联合委员会第7版）以及胸段食管中上段疾病的比例分别为68%、44%、54%和59%，手术组分别为64%、47%、55%和64%。CRT组的3年和5年总生存率分别为47.1%和34.0%，手术组为68.3%和54.4%（p = 0.0019）。CRT组的3年和5年无进展生存率分别为45.3%和38.8%，手术组为61.1%和54.4%（p = 0.022）。
尽管不能排除对选择非手术治疗方法的患者存在选择偏倚，特别是因为手术是该机构的标准治疗方法，但CRT在生存率方面可能不如手术。需要进行前瞻性随机临床试验才能得出明确结论。
