Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas.
Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas.
JAMA Oncol. 2018 Jan 1;4(1):31-38. doi: 10.1001/jamaoncol.2017.2805.
Distant recurrence following preoperative chemoradiotherapy and resection in patients with gastroesophageal adenocarcinoma is common. Adjuvant chemotherapy may improve survival.
To compare adjuvant chemotherapy with postoperative observation following preoperative chemoradiotherapy and resection in patients with gastroesophageal adenocarcinoma.
DESIGN, SETTING, AND PARTICIPANTS: Propensity score-matched analysis using the National Cancer Database. We included adult patients who received a diagnosis between 2006 and 2013 of clinical stage T1N1-3M0 or T2-4N0-3M0 adenocarcinoma of the distal esophagus or gastric cardia who were treated with preoperative chemoradiotherapy and curative-intent resection. Patients receiving adjuvant chemotherapy were matched by propensity score to patients undergoing postoperative observation.
Adjuvant chemotherapy and postoperative observation.
Overall survival.
We identified 10 086 patients (8840 [88%] male; mean [SD] age, 61 [9.5] years), 9272 in the postoperative observation group and 814 in the adjuvant chemotherapy group. Patients receiving adjuvant chemotherapy were younger (18-54 years: 252 [31%] vs 1989 [21%]; P < .001) and were more likely to have advanced disease (ypT3/4: 458 [62%] vs 3531 [46%]; P < .001; ypN+: 572 [72%] vs 3428 [39%]; P < .001), as well as shorter postoperative inpatient stays (>2 weeks: 94 [13%] vs 1589 [20%]; P < .001). A total of 732 patients in the adjuvant chemotherapy group were matched by propensity score to 3660 patients in the postoperative observation group. Adjuvant chemotherapy was associated with improved overall survival compared with postoperative observation (median survival: 40 months; 95% CI, 36-46 months vs 34 months; 95% CI, 32-35 months; stratified log-rank P < .001; hazard ratio, 0.79; 95% CI, 0.72-0.88). Overall survival at 1, 3, and 5 years was 88%, 47%, and 34% in the observation group, and 94%, 54%, and 38% in the adjuvant chemotherapy group, respectively. Adjuvant chemotherapy was associated with a survival benefit compared with postoperative observation in most patient subgroups.
For patients with locally advanced gastroesophageal adenocarcinoma treated with preoperative chemoradiotherapy and resection, adjuvant chemotherapy was associated with improved overall survival. Our findings have important implications for the postoperative treatment of this patient group for which few data are available.
术前放化疗和切除术治疗的胃食管腺癌患者远处复发很常见。辅助化疗可能改善生存。
比较术前放化疗和切除术治疗胃食管腺癌患者中辅助化疗与术后观察。
设计、设置和参与者：使用国家癌症数据库进行倾向评分匹配分析。我们纳入了 2006 年至 2013 年间诊断为 T1N1-3M0 或 T2-4N0-3M0 远端食管或胃贲门腺癌的成年患者，这些患者接受了术前放化疗和根治性切除术。接受辅助化疗的患者根据倾向评分与接受术后观察的患者相匹配。
辅助化疗和术后观察。
总生存期。
我们确定了 10486 例患者（8840 例男性；平均[标准差]年龄，61[9.5]岁），术后观察组 9272 例，辅助化疗组 814 例。接受辅助化疗的患者年龄较小（18-54 岁：252[31%] vs 1989[21%]；P<0.001），更有可能患有晚期疾病（ypT3/4：458[62%] vs 3531[46%]；P<0.001；ypN+：572[72%] vs 3428[39%]；P<0.001），且术后住院时间较短（>2 周：94[13%] vs 1589[20%]；P<0.001）。辅助化疗组的 732 例患者通过倾向评分与术后观察组的 3660 例患者相匹配。与术后观察组相比，辅助化疗组的总生存期有所改善（中位生存期：40 个月；95%CI，36-46 个月 vs 34 个月；95%CI，32-35 个月；分层对数秩 P<0.001；风险比，0.79；95%CI，0.72-0.88）。观察组的 1、3 和 5 年总生存率分别为 88%、47%和 34%，辅助化疗组分别为 94%、54%和 38%。辅助化疗与术后观察组相比，在大多数患者亚组中均有生存获益。
对于接受术前放化疗和切除术治疗的局部晚期胃食管腺癌患者，辅助化疗可改善总生存期。我们的发现对该患者群体的术后治疗具有重要意义，因为该群体的数据很少。
