淋巴结阳性食管癌新辅助放疗与辅助放疗的生存获益：一项基于人群的分析。

Survival benefit of neoadjuvant versus adjuvant radiotherapy in lymph node positive esophageal cancer: a population based analysis.

作者信息

Thumallapally Nishitha, Meshref Ahmed, Mousa Mohammed, Hendawi Mohamed, Lan Mei, Salem Ahmed I, Forte Frank

机构信息

Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA.

Department of Medicine, Suez Canal University, Ismailia, Egypt.

出版信息

J Gastrointest Oncol. 2017 Oct;8(5):825-832. doi: 10.21037/jgo.2017.06.19.

DOI:10.21037/jgo.2017.06.19

PMID:29184686

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5674253/

Abstract

BACKGROUND

The impact of radiotherapy on the survival of patients with locally advanced esophageal cancer (EC) is presently insufficiently explored. Thus, using data from the Surveillance, Epidemiology, and End Results (SEER) Registry, this study aimed to compare the survival rates of patients with lymph node (LN) positive EC who received curative resection and were treated by neoadjuvant and adjuvant radiotherapy (RT), respectively.

METHODS

Retrospectively collected data from the SEER database using all 18 SEER registries on patients that underwent esophagectomy for EC was evaluated. All patients with LN positive pathology who received either neoadjuvant or adjuvant RT and curative intent esophagectomy from 2004 to 2007 were included. A comparison of 5-year relative survival outcome among groups categorized by sex, race, age, histology, and tumor size was performed.

RESULTS

A total of 933 patients were evaluated; 636 (69%) and 297 (31%) received RT in neoadjuvant and adjuvant setting respectively. Their overall 5-year relative survival rates were 32.8% (95% CI: 28.7-36.9) and 26.5% (95% CI: 21-32.3) (P=0.058). Patients in the neoadjuvant RT group who underwent curative resection for squamous cell carcinoma (SCC) of EC had an improved 5-year relative survival rate of 43.4% (95% CI: 32.5-53.8) compared to 26.5% (95% CI: 15.4-38.9) measured for the adjuvant RT group (P=0.03). The results further revealed a significant increase in the 5-year relative survival rates for stage T3 and Tx when RT was given in neoadjuvant setting compared to adjuvant RT group (T3 28.5% 20.2%, P=0.011; Tx 46.3% 8.9%, P=0.021). When the patients were grouped according to race, sex or age, or based on the timing of radiation relative to surgery, in the other histological or T stage groups, there were no statistically significant differences in the 5-year survival rates.

CONCLUSIONS

Compared to adjuvant radiotherapy, neoadjuvant radiotherapy results in a better 5-year relative survival in patients with squamous cell neoplasms and/or T3, Tx stage disease.

摘要

背景

目前，放疗对局部晚期食管癌（EC）患者生存的影响尚未得到充分研究。因此，本研究利用监测、流行病学和最终结果（SEER）数据库的数据，旨在比较接受根治性切除且分别接受新辅助和辅助放疗（RT）的淋巴结（LN）阳性EC患者的生存率。

方法

回顾性收集来自18个SEER登记处的SEER数据库中接受EC食管切除术患者的数据并进行评估。纳入2004年至2007年期间所有LN病理阳性且接受新辅助或辅助RT以及根治性食管切除术的患者。对按性别、种族、年龄、组织学和肿瘤大小分类的组间5年相对生存结果进行比较。

结果

共评估了933例患者；636例（69%）和297例（31%）分别在新辅助和辅助治疗中接受了RT。他们的总体5年相对生存率分别为32.8%（95%CI：28.7 - 36.9）和26.5%（95%CI：21 - 32.3）（P = 0.058）。新辅助RT组中接受EC鳞状细胞癌（SCC）根治性切除的患者5年相对生存率提高至43.4%（95%CI：32.5 - 53.8），而辅助RT组为26.5%（95%CI：15.4 - 38.9）（P = 0.03）。结果还显示，与辅助RT组相比，新辅助治疗时给予RT的T3期和Tx期患者5年相对生存率显著提高（T3期：28.5%对20.2%，P = 0.011；Tx期：46.3%对8.9%，P = 0.021）。当根据种族、性别或年龄，或根据放疗相对于手术的时间对患者进行分组时，在其他组织学或T分期组中，5年生存率无统计学显著差异。