一项倾向评分匹配分析比较了 R0 食管切除术后淋巴结阳性或 III 期食管鳞癌患者单纯手术与术后治疗的长期生存。
A propensity-score matching analysis comparing long-term survival of surgery alone and postoperative treatment for patients in node positive or stage III esophageal squamous cell carcinoma after R0 esophagectomy.
机构信息
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Oncology/ Radiation Oncology, Beijing Chao-yang Hospital, Beijing, China.
Department of Radiation Oncology, Tianjing Medical University Cancer Institute and Hospital, National Clinical Research Centre of Cancer, Tianjin, China.
出版信息
Radiother Oncol. 2019 Nov;140:159-166. doi: 10.1016/j.radonc.2019.06.020. Epub 2019 Jul 11.
BACKGROUND
Surveillance was recommended for patients after R0 esophagectomy by National Comprehensive Cancer Network (NCCN) guidelines. However, local failure was high in locally advanced patients (48-78%). The present study aimed to determine whether adjuvant treatment improved survival for stage IIb-III thoracic esophageal squamous cell carcinoma (TESCC).
METHODS
A retrospective review of patients diagnosed as esophageal carcinoma at the Chinese Academy of Medical Sciences Cancer hospital, between January 2004 and December 2011, was performed. A database compiling 975 patents with node positive or stage III thoracic esophageal carcinoma after R0 surgery with or without postoperative radiation/chemoradiation was created. A 1:1 matched study group was generated by the Greedy method after propensity score matching (PSM) analysis. Survival curves were calculated by the Kaplan-Meier method and compared with the log-rank test. Univariate and multivariate analyses were using the Cox proportional hazards regression model.
RESULTS
975 patients were enrolled in the study, 510 patients (52.3%) did not receive any postoperative treatment after R0 surgery and 465 patients had either postoperative chemoradiation or radiotherapy. Median follow-up was 69.2 months. After PSM, 222 well-balanced patients in each group demonstrated the same results. The 3-year, 5-year survival rates and median survival in surgery group (33.0%, 26.4%, 24.3 months) were inferior to those in postoperative treatment group (48.3%, 37.1% and 34.3 months), (P = 0.002). Compared with radiotherapy, postoperative chemoradiation did not improve DFS and OS (P = 0.692; P = 0.368). N stage and adjuvant treatment are independent prognostic factors.
CONCLUSIONS
Adjuvant treatment could improve survival for patients with stage IIb-III TESCC.
背景
美国国家综合癌症网络（NCCN）指南建议对 R0 食管切除术患者进行监测。然而，局部晚期患者（48-78%）局部失败率较高。本研究旨在确定辅助治疗是否能提高 IIb-III 期胸段食管鳞癌（TESCC）患者的生存率。
方法
对 2004 年 1 月至 2011 年 12 月在中国医学科学院肿瘤医院诊断为食管癌的患者进行回顾性分析。创建了一个包含 975 例接受 R0 手术后接受或不接受术后放疗/放化疗且淋巴结阳性或 III 期胸段食管癌患者的数据库。通过倾向评分匹配（PSM）分析后，采用贪婪法生成 1:1 匹配的研究组。采用 Kaplan-Meier 法计算生存曲线，并采用对数秩检验进行比较。采用 Cox 比例风险回归模型进行单因素和多因素分析。
结果
本研究共纳入 975 例患者，510 例（52.3%）患者在 R0 手术后未接受任何术后治疗，465 例患者接受术后放化疗或放疗。中位随访时间为 69.2 个月。PSM 后，每组各有 222 例匹配良好的患者，结果相同。手术组 3 年、5 年生存率及中位生存时间（33.0%、26.4%、24.3 个月）均低于术后治疗组（48.3%、37.1%、34.3 个月）（P=0.002）。与放疗相比，术后放化疗并未改善无病生存率和总生存率（P=0.692；P=0.368）。N 分期和辅助治疗是独立的预后因素。
结论
辅助治疗可提高 IIb-III 期 TESCC 患者的生存率。
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