Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands.
Ann Surg Oncol. 2019 Apr;26(4):986-995. doi: 10.1245/s10434-019-07181-6. Epub 2019 Feb 4.
This study was designed to assess the impact of age and comorbidity on choice and outcome of definitive chemoradiotherapy (dCRT) or neoadjuvant chemoradiotherapy plus surgery.
In this population-based study, all patients with potentially curable EC (cT1N+/cT2-3, TX, any cN, cM0) diagnosed in the South East of the Netherlands between 2004 and 2014 were included. Kaplan-Meier method with log-rank tests and multivariable Cox regression analysis were used to compare overall survival (OS).
A total of 702 patients was included. Age ≥ 75 years and multiple comorbidities were associated with a higher probability for dCRT (odds ratio [OR] 8.58; 95% confidence interval [CI] 4.72-15.58; and OR 3.09; 95% CI 1.93-4.93). The strongest associations were found for the combination of hypertension plus diabetes (OR 3.80; 95% CI 1.97-7.32) and the combination of cardiovascular with pulmonary comorbidity (OR 3.18; 95% CI 1.57-6.46). Patients with EC who underwent dCRT had a poorer prognosis than those who underwent nCRT plus surgery, irrespective of age, number, and type of comorbidities. In contrast, for patients with squamous cell carcinoma with ≥ 2 comorbidities or age ≥ 75 years, OS was comparable between both groups (hazard ratio [HR] 1.52; 95% CI 0.78-2.97; and HR 0.73; 95% CI 0.13-4.14).
Histological tumor type should be acknowledged in treatment choices for patients with esophageal cancer. Neoadjuvant chemoradiotherapy plus surgery should basically be advised as treatment of choice for operable esophageal adenocarcinoma patients. For patients with esophageal squamous cell carcinoma with ≥ 2 comorbidities or age ≥ 75 years, dCRT may be the preferred strategy.
本研究旨在评估年龄和合并症对根治性放化疗（dCRT）或新辅助放化疗加手术选择和结局的影响。
在这项基于人群的研究中，纳入了 2004 年至 2014 年间在荷兰东南部被诊断为可治愈的 EC（cT1N+/cT2-3、TX、任何 cN、cM0）的所有患者。使用 Kaplan-Meier 方法和对数秩检验以及多变量 Cox 回归分析来比较总生存率（OS）。
共纳入 702 例患者。年龄≥75 岁和多种合并症与 dCRT 的可能性更高相关（优势比 [OR] 8.58；95%置信区间 [CI] 4.72-15.58；和 OR 3.09；95% CI 1.93-4.93）。最强的关联见于高血压加糖尿病（OR 3.80；95% CI 1.97-7.32）和心血管加肺部合并症（OR 3.18；95% CI 1.57-6.46）的组合。接受 dCRT 的 EC 患者的预后不如接受 nCRT 加手术的患者，无论年龄、合并症数量和类型如何。相比之下，对于患有≥2 种合并症或年龄≥75 岁的鳞状细胞癌患者，两组之间的 OS 相当（风险比 [HR] 1.52；95% CI 0.78-2.97；和 HR 0.73；95% CI 0.13-4.14）。
在治疗食管癌患者时，应考虑组织学肿瘤类型。新辅助放化疗加手术应基本作为可手术食管腺癌患者的首选治疗方法。对于患有≥2 种合并症或年龄≥75 岁的食管鳞状细胞癌患者，dCRT 可能是首选策略。
