同步放化疗后序贯顺铂/5-FU 巩固化疗与单纯同步放化疗治疗 II-III 期食管鳞癌的倾向性评分匹配分析。
With or without consolidation chemotherapy using cisplatin/5-FU after concurrent chemoradiotherapy in stage II-III squamous cell carcinoma of the esophagus: A propensity score-matched analysis.
机构信息
Department of Clinical Oncology, Renmin Hospital of Wuhan University, China; Department of Radiation Oncology, Zhengzhou University Affiliated Cancer Hospital, China.
Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, China.
出版信息
Radiother Oncol. 2018 Oct;129(1):154-160. doi: 10.1016/j.radonc.2017.10.031. Epub 2017 Nov 6.
BACKGROUND AND PURPOSE
The benefit of consolidation chemotherapy for locally advanced squamous cell carcinoma of the esophagus is unknown. The aim of this study was to investigate the efficacy of consolidation chemotherapy with cisplatin and 5-fluorouracil (5-FU) after concurrent chemoradiotherapy (CCRT) with the same agents in patients with stage II-III disease.
MATERIAL AND METHODS
Data for patients with stage II-III squamous cell carcinoma of the esophagus treated with CCRT were retroactively reviewed. Patients who received CCRT alone (observation group) were compared with those who underwent CCRT followed by consolidation chemotherapy (consolidation group) with regard to progression-free survival, overall survival, treatment failure and toxicity. Differences in baseline characteristics were adjusted using the propensity score matching method.
RESULTS
From September 2006 to September 2012, 812 patients were recruited (n = 272 for observation; n = 540 for consolidation). Among them, 290 (35.7%) had clinical stage II disease and 522 (64.3%) had stage III disease. In the overall study cohort, the median progression-free survival (22.1 months vs. 22.0 months, P = 0.917) and median overall survival (33.8 months vs. 31.3 months, P = 0.591) were comparable between the observation group and consolidation group. Comparisons of the observation and consolidation group in the matched population (262 patients in each group) showed median progression-free survival of 23.0 months and 25.4 months (hazard ratio [HR], 0.93; 95% CI [confidence interval], 0.74-1.15; P = 0.491), and median overall survival of 34.6 months and 35.0 months (HR, 0.92; 95% CI, 0.80-1.27; P = 0.919), respectively. There were no significant differences in local/regional failure and persistence disease (50.4% vs. 48.5%) and distant failure (10.7% vs. 8.8%) between the two groups.
CONCLUSIONS
Compared to CCRT alone, consolidation chemotherapy did not further prolong progression-free survival and overall survival for patients with stage II-III squamous cell carcinoma of the esophagus. The role of consolidation therapy needs to be studied further.
背景与目的
局部晚期食管鳞状细胞癌巩固化疗的益处尚不清楚。本研究旨在探讨顺铂和 5-氟尿嘧啶（5-FU）巩固化疗在接受相同药物同步放化疗（CCRT）的 II-III 期患者中的疗效。
材料与方法
回顾性分析接受 CCRT 治疗的 II-III 期食管鳞状细胞癌患者的数据。将接受单纯 CCRT（观察组）的患者与接受 CCRT 后巩固化疗（巩固组）的患者进行无进展生存期、总生存期、治疗失败和毒性比较。采用倾向评分匹配法调整基线特征差异。
结果
2006 年 9 月至 2012 年 9 月，共纳入 812 例患者（观察组 272 例，巩固组 540 例）。其中 290 例（35.7%）为临床 II 期疾病，522 例（64.3%）为 III 期疾病。在整个研究队列中，观察组和巩固组的中位无进展生存期（22.1 个月 vs. 22.0 个月，P=0.917）和中位总生存期（33.8 个月 vs. 31.3 个月，P=0.591）无显著差异。在匹配人群（每组 262 例）中，观察组和巩固组的中位无进展生存期分别为 23.0 个月和 25.4 个月（风险比[HR]，0.93；95%置信区间[CI]，0.74-1.15；P=0.491），中位总生存期分别为 34.6 个月和 35.0 个月（HR，0.92；95%CI，0.80-1.27；P=0.919）。两组局部/区域失败和持续疾病（50.4% vs. 48.5%）和远处失败（10.7% vs. 8.8%）无显著差异。
结论
与单纯 CCRT 相比，巩固化疗并未进一步延长 II-III 期食管鳞状细胞癌患者的无进展生存期和总生存期。巩固治疗的作用需要进一步研究。
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