Tsukada Yoichiro, Higashi Takahiro, Shimada Hideaki, Kikuchi Yoshinori, Terahara Atsuro
Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan.
Int J Clin Oncol. 2018 Feb;23(1):81-91. doi: 10.1007/s10147-017-1178-y. Epub 2017 Aug 9.
Recent studies have shown the benefits of neoadjuvant therapy with chemotherapy or chemoradiotherapy for resectable locally advanced thoracic esophageal squamous cell carcinoma (ESCC). The aim of our study was to elucidate the use of neoadjuvant therapy for thoracic ESCC in Japan.
Data on patients with stage IB-III thoracic ESCC were retrieved from the national database of hospital-based cancer registries combined with claims data between 2012 and 2013. These data were analyzed using a mixed-effect logistic regression analysis, with a focus on exploring patterns in the first-line treatment for ESCC, including proportion of patients who received neoadjuvant therapy, and investigating the hospital characteristics and patient factors associated with the use of neoadjuvant therapy.
Of the 5016 patients with stage IB-III thoracic ESCC at the 305 participating hospitals, 34.2% received neoadjuvant therapy (neoadjuvant chemotherapy, 29.5%; neoadjuvant chemoradiotherapy, 4.7%). The therapy was less likely to be administered to older patients (≤64 years, 48.8%; 65-70 years, 42.0%; 70-75 years, 33.9%; 75-80 years, 22.2%; 80-85 years, 3.8%; ≥85 years, 1.4%) and at hospitals with a low volume of patients (very high, 42.1%; high, 37.5%; low, 30.7%; and very low, 26.4%). This trend was confirmed by regression analysis.
Based on our results, in Japan, relatively few patients with resectable locally advanced thoracic ESCC receive neoadjuvant therapy, with older patients and patients at lower volume hospitals being less likely than other patients to receive the neoadjuvant therapy. We recommend that the process of treatment decision-making be assessed at both the patient and hospital levels so that patients can consider various treatment options, including neoadjuvant therapy with surgery in Japan.
近期研究表明，新辅助化疗或放化疗对可切除的局部晚期胸段食管鳞状细胞癌（ESCC）有益。我们研究的目的是阐明日本胸段ESCC新辅助治疗的应用情况。
从基于医院的癌症登记国家数据库中检索2012年至2013年期间IB - III期胸段ESCC患者的数据，并结合理赔数据。使用混合效应逻辑回归分析对这些数据进行分析，重点探讨ESCC一线治疗模式，包括接受新辅助治疗的患者比例，并调查与新辅助治疗使用相关的医院特征和患者因素。
在305家参与研究的医院中，5016例IB - III期胸段ESCC患者中，34.2%接受了新辅助治疗（新辅助化疗，29.5%；新辅助放化疗，4.7%）。老年患者（≤64岁，48.8%；65 - 70岁，42.0%；70 - 75岁，33.9%；75 - 80岁，22.2%；80 - 85岁，3.8%；≥85岁，1.4%）以及患者数量较少的医院（非常高，42.1%；高，37.5%；低，30.7%；非常低，26.4%）接受该治疗的可能性较小。回归分析证实了这一趋势。
基于我们的研究结果，在日本，相对较少的可切除局部晚期胸段ESCC患者接受新辅助治疗，老年患者和患者数量较少医院的患者比其他患者接受新辅助治疗的可能性更小。我们建议在患者和医院层面评估治疗决策过程，以便患者能够考虑各种治疗选择，包括日本的新辅助治疗联合手术。
