Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York.
Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, New York.
J Surg Res. 2019 Apr;236:259-265. doi: 10.1016/j.jss.2018.11.052. Epub 2018 Dec 24.
Neoadjuvant treatment improves survival for patients undergoing esophagectomy for esophageal cancer. Recent evidence suggests that neoadjuvant chemoradiation offers no advantage over chemotherapy alone before surgical resection for adenocarcinoma histology. We sought to examine if this applies to patients with squamous cell histology.
The National Cancer Database was queried for patients who underwent treatment for squamous cell carcinoma of the esophagus from 2004 to 2012. Patients who underwent neoadjuvant chemotherapy before esophagectomy were compared with those undergoing chemotherapy and radiation before surgical resection. Associations between potential covariates and treatment were analyzed using the Pearson chi-square test for categorical variables and Wilcoxon rank sum test for continuous variables. Univariate and multivariate proportional hazards modeling results were used to assess the effect of treatment on overall survival. Relative prognosis was summarized using estimates and 95% confidence limits for the hazard ratio. Unadjusted differences in overall survival and disease-specific survival between the treatment are shown using Kaplan-Meier methods.
A total of 902 patients underwent neoadjuvant therapy before surgical resection during the study period, with 827 receiving chemotherapy and radiation, and 75 receiving chemotherapy alone preoperatively. The 30- and 90-d mortality for patients undergoing neoadjuvant chemotherapy and radiation followed by surgery were 5.4% and 10.4% compared to 5.5% and 11.1% for patients who received chemotherapy alone preoperatively (P = 0.963 and P = 0.856), respectively. Median overall survival for patients receiving chemotherapy and radiation was 36.0 mo versus 40.8 mo for chemotherapy alone. The 5-y survival was 39% for the chemotherapy and radiation group and 43% for the chemotherapy group (logrank P = 0.7212).
For patients undergoing neoadjuvant treatment before planned surgical resection of squamous cell carcinoma of the esophagus, the addition of radiation to neoadjuvant chemotherapy did not improve long-term survival and did not appear to impact short-term outcomes postoperatively. Further study with a randomized phase III trial is needed.
新辅助治疗可改善接受食管癌切除术的患者的生存率。最近的证据表明，与单独接受化疗相比，新辅助放化疗并未为腺癌组织学患者带来优势，在接受手术切除前。我们试图检查这是否适用于患有鳞状细胞组织学的患者。
从 2004 年至 2012 年，国家癌症数据库查询了接受食管鳞状细胞癌治疗的患者。将接受新辅助化疗后行食管切除术的患者与接受化疗和放疗后行手术切除的患者进行比较。使用 Pearson 卡方检验分析分类变量和 Wilcoxon 秩和检验分析连续变量之间潜在协变量和治疗之间的关联。使用单变量和多变量比例风险模型结果评估治疗对总生存的影响。使用风险比的估计值和 95%置信区间总结相对预后。使用 Kaplan-Meier 方法显示治疗之间总生存和疾病特异性生存的无调整差异。
在研究期间，共有 902 例患者在手术切除前接受新辅助治疗，其中 827 例接受化疗和放疗，75 例术前单独接受化疗。接受新辅助化疗和放疗后再行手术的患者的 30 天和 90 天死亡率分别为 5.4%和 10.4%，而术前单独接受化疗的患者分别为 5.5%和 11.1%（P=0.963 和 P=0.856）。接受化疗和放疗的患者的中位总生存期为 36.0 个月，而单独接受化疗的患者为 40.8 个月。化疗和放疗组的 5 年生存率为 39%，化疗组为 43%（对数秩 P=0.7212）。
对于计划接受新辅助治疗后手术切除的食管鳞状细胞癌患者，新辅助化疗中添加放疗并未改善长期生存，并且似乎不会影响术后短期结果。需要进一步进行随机 III 期试验研究。
