Department of Radiation Oncology, Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, TRC 2 West, Philadelphia, PA 19104, United States.
Department of Biostatistics and Epidemiology, University of Pennsylvania, 622 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, United States.
J Geriatr Oncol. 2018 Jan;9(1):40-46. doi: 10.1016/j.jgo.2017.08.010. Epub 2017 Sep 6.
The aim of this study was to characterize outcomes associated with neoadjuvant chemoradiation prior to esophagectomy, compared to esophagectomy alone, in older patients with esophageal cancer.
We conducted an observational cohort study in patients ≥70years with locally-advanced esophageal cancer undergoing esophagectomy ± neoadjuvant chemoradiation between 2006 and 2012 using the National Cancer Database. A Cox proportional hazards model with inverse probability of treatment weighting (IPTW) using the propensity score was developed to assess the association between trimodality therapy and overall survival. Perioperative complications and pathologic outcomes associated with trimodality therapy were identified with multivariable logistic regression.
1364 patients were included; the mean age was 75 (range 70-90). 904 (66%) were treated with trimodality therapy and 460 (34%) were treated with esophagectomy alone. On IPTW Cox analysis, neoadjuvant chemoradiation was associated with improved overall survival (HR=0.76, 95%CI [0.70-0.82], p≤0.001). Further, trimodality therapy was associated with lower rates of margin-positive resection (5% vs. 18%; OR=0.26, 95%CI [0.18-0.37], p<0.001) and in 18% of trimodality patients, there was no detectable tumor at surgery. 90-day mortality rates were not statistically different (14% vs. 12%; OR=0.99, 95%CI [0.73-1.36], p=0.22). Neoadjuvant chemoradiation was associated with lower 30-day readmission rates (5% vs. 8%; OR=0.48, 95%CI [0.31-0.73], p=0.004) and shorter surgical hospital stay (median 10 vs. 12days, p<0.001) compared to esophagectomy alone.
In older patients with esophageal cancer, trimodality therapy, compared to esophagectomy alone, is associated with improved overall survival and favorable pathologic and perioperative outcomes. Further studies are needed to identify which older patients are most suitable for trimodality therapy.
本研究旨在分析比较新辅助放化疗联合手术与单纯手术治疗 70 岁以上局部晚期食管癌患者的预后。
我们利用国家癌症数据库，对 2006 年至 2012 年间接受手术联合或不联合新辅助放化疗的 70 岁以上局部晚期食管癌患者进行了一项观察性队列研究。采用逆概率治疗加权（IPTW）的 Cox 比例风险模型和倾向评分评估三联疗法与总生存之间的关系。采用多变量逻辑回归分析评估三联疗法与围手术期并发症和病理结果的关系。
共纳入 1364 例患者，平均年龄为 75 岁（70-90 岁）。904 例（66%）接受了三联疗法治疗，460 例（34%）接受了单纯手术治疗。在 IPTW Cox 分析中，新辅助放化疗与改善的总生存率相关（HR=0.76，95%CI [0.70-0.82]，p≤0.001）。此外，三联疗法与较低的切缘阳性率相关（5% vs. 18%；OR=0.26，95%CI [0.18-0.37]，p<0.001），在 18%的三联疗法患者中，手术时未检测到肿瘤。90 天死亡率无统计学差异（14% vs. 12%；OR=0.99，95%CI [0.73-1.36]，p=0.22）。新辅助放化疗与较低的 30 天再入院率相关（5% vs. 8%；OR=0.48，95%CI [0.31-0.73]，p=0.004）和较短的手术住院时间（中位数 10 天 vs. 12 天，p<0.001）相关。
与单纯手术相比，新辅助放化疗联合手术治疗 70 岁以上局部晚期食管癌患者可改善总生存率，并获得良好的病理和围手术期结果。需要进一步研究以确定哪些老年患者最适合接受三联疗法。
