Di Corpo Marco, Schlottmann Francisco, Strassle Paula D, Nurczyk Kamil, Patti Marco G
1Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
2Department of Surgery, Hospital Alemán of Buenos Aires, University of Buenos Aires, Buenos Aires, Argentina.
J Laparoendosc Adv Surg Tech A. 2019 Aug;29(8):989-994. doi: 10.1089/lap.2019.0350. Epub 2019 Jun 26.
Owing to the rising incidence of esophageal adenocarcinoma (EAC), we sought to assess the national trends in the use of different treatment modalities and compare survival outcomes among them. Using Surveillance, Epidemiology, and End Results (SEER) Program registry (2004-2014), we identified adult patients diagnosed with EAC undergoing definitive chemoradiotherapy (dCRT), esophagectomy, or neoadjuvant chemoradiotherapy plus esophagectomy (nCRT/S). Linear trends in the yearly incidence of each treatment were assessed using Poisson regression. An inverse probability of treatment weighted (IPTW) Cox regression was used to estimate the effect of each treatment on mortality. IPTW was used to account for potential confounding by year of diagnosis, patient demographics, and cancer characteristics. A total of 10,755 patients were included in the study. From 2004 to 2014, the use of esophagectomy alone decreased from 15% to 5% ( < .0001), whereas nCRT/S increased from 14% to 20% ( < .0001); dCRT remained relatively stable (26% to 29%, = .08). The 60-month survival rate was 13.0% for dCRT, 33.0% for esophagectomy only, and 36.3% for nCRT/S. After accounting for patient and cancer characteristics, both esophagectomy (hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.55-0.70, < .0001) and nCRT/S (HR 0.45, 95% CI 0.41-0.48, < .0001) had significantly the highest survival rates. The use of esophagectomy alone has decreased, whereas nCRT/S has increased among EAC patients. Considering the better outcomes achieved with surgical resection, the use of dCRT should be discouraged in surgically fit patients.
由于食管腺癌（EAC）的发病率不断上升，我们试图评估不同治疗方式使用情况的全国趋势，并比较它们之间的生存结果。利用监测、流行病学和最终结果（SEER）计划登记处（2004 - 2014年）的数据，我们确定了被诊断为EAC并接受根治性放化疗（dCRT）、食管切除术或新辅助放化疗加食管切除术（nCRT/S）的成年患者。使用泊松回归评估每种治疗的年发病率的线性趋势。采用治疗加权逆概率（IPTW）Cox回归来估计每种治疗对死亡率的影响。IPTW用于考虑诊断年份、患者人口统计学特征和癌症特征可能造成的混杂因素。该研究共纳入10755例患者。从2004年到2014年，单纯食管切除术的使用比例从15%降至5%（P < 0.0001），而nCRT/S从14%增至20%（P < 0.0001）；dCRT保持相对稳定（从26%至29%，P = 0.08）。dCRT的60个月生存率为13.0%，单纯食管切除术为33.0%，nCRT/S为36.3%。在考虑患者和癌症特征后，食管切除术（风险比[HR] 0.62，95%置信区间[CI] 0.55 - 0.70，P < 0.0001）和nCRT/S（HR 0.45，95% CI 0.41 - 0.48，P < 0.0001）的生存率均显著最高。单纯食管切除术的使用减少，而EAC患者中nCRT/S的使用增加。鉴于手术切除取得了更好的结果，对于适合手术的患者应不鼓励使用dCRT。
