Department of Surgery, University of Louisville School of Medicine, 201 Abraham Flexner Way, Ste 1200, Louisville, KY, 40202, USA.
Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
J Gastrointest Surg. 2019 Apr;23(4):670-678. doi: 10.1007/s11605-019-04141-z. Epub 2019 Feb 20.
Neoadjuvant chemoradiotherapy followed by resection is standard of care for patients with locally advanced esophageal cancer, however, a significant portion of these patients do not undergo surgical intervention. This study evaluates radiation dose and other factors associated with undergoing esophageal resection and their impact on outcomes including survival.
Patients diagnosed with esophageal cancer between 2010 and 15 were queried from the National Cancer Database and stratified into low-dose radiation (41.4 Gy) (LDR) or high-dose radiation (50.0 or 50.4 Gy) (HDR) groups. Multivariable Logistic and Cox Regression analyses were performed to investigate the effect of multiple variables on the likelihood of undergoing esophagectomy and overall survival, respectively. Propensity score matching was performed to reduce bias between groups.
A total of 3633 patients met study criteria with 3005 (82.7%) undergoing esophagectomy. A greater proportion received HDR (3163 (87.1%)) than LDR (470 (12.9%)). The use of LDR increased from 4.7% (n = 22) in 2010 to 20.7% (n = 154) in 2015. Factors associated with undergoing esophagectomy included LDR, adenocarcinoma histology, and younger age. Radiation dosage did not impact overall survival, but undergoing esophagectomy was associated with improved survival. After propensity matching, a greater portion of the LDR group underwent esophagectomy (87.0 vs 81.1%, p = 0.013). There was no difference in R0 3 resection (93.2 vs 92.4%, p = 0.678) or complete pathologic response (19.3 vs 21.5%, p = 0.442) between LDR and HDR groups.
The use of LDR is increasing but still underutilized. LDR is associated with increased rates of esophagectomy without negatively impacting overall survival, R0 resection, or complete pathologic response.
新辅助放化疗后行切除术是局部晚期食管癌患者的标准治疗方法，但其中相当一部分患者未行手术干预。本研究评估了与接受食管切除术相关的放射剂量和其他因素及其对包括生存在内的结局的影响。
从国家癌症数据库中查询了 2010 年至 2015 年间诊断为食管癌的患者，并将其分为低剂量放疗（41.4 Gy）（LDR）或高剂量放疗（50.0 或 50.4 Gy）（HDR）组。采用多变量逻辑和 Cox 回归分析分别研究了多种变量对行食管切除术的可能性和总生存率的影响。进行倾向评分匹配以减少组间偏倚。
共有 3633 例患者符合研究标准，其中 3005 例（82.7%）行食管切除术。接受 HDR 的比例（3163 例[87.1%]）明显高于 LDR（470 例[12.9%]）。2010 年 LDR 的使用率为 4.7%（n=22），2015 年上升至 20.7%（n=154）。与行食管切除术相关的因素包括 LDR、腺癌组织学和年龄较小。放射剂量与总生存率无关，但行食管切除术与生存改善相关。经倾向评分匹配后，LDR 组更多患者行食管切除术（87.0%比 81.1%，p=0.013）。LDR 和 HDR 组的 R0 3 切除率（93.2%比 92.4%，p=0.678）或完全病理缓解率（19.3%比 21.5%，p=0.442）无差异。
LDR 的应用正在增加，但仍未得到充分利用。LDR 与食管切除术率增加相关，而不会对总生存率、R0 切除率或完全病理缓解率产生负面影响。
