Victor Carolina Ribeiro, Fujiki Fernanda Kaori, Takeda Flavio Roberto, Hoff Paulo Marcelo Gehm, de Castria Tiago Biachi
Universidade de São Paulo Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil.
J Glob Oncol. 2019 Jul;5:1-10. doi: 10.1200/JGO.19.00103.
Despite epidemiologic and molecular differences between esophageal and stomach cancers, most published studies have included patients with either disease in a metastatic scenario. We evaluated the safety and effectiveness of chemotherapy in patients with metastatic esophageal cancer in the community setting.
We performed a retrospective cohort study of patients with synchronous metastatic esophageal cancer treated at a public hospital between 2008 and 2016. Patients were grouped according to a prescribed chemotherapy protocol: platinum and taxane (group A); platinum and irinotecan (group B); platinum and fluoropyrimidine (group C); and without platinum (group D).
Of the 1,789 patients with esophageal cancer treated, we included 397 with metastatic disease at presentation. Squamous cell carcinoma was the most frequent histology (78.8%). Median overall survival (OS) was 7 months (95% CI, 6.15 to 7.85 months). Chemotherapy was administered to 285 patients, who reached a median OS of 9.0 months (95% CI, 8.0 to 9.9 months); for 112 patients who did not receive treatment, median OS was 3 months (95% CI, 2.3 to 3.7 months; < .001). The most used combination was platinum plus irinotecan (A; 55.5%). Disease control with in groups A, B, C, and D was 39.2%, 30.1%, 53% and 14.3%, respectively. Patients in group C reached a median OS of 17 months (95% CI, 13.1 to 20.8 months; = .034). No differences were observed in median OS obtained with other protocols (9 months). The toxicity profile was different according to chemotherapy, with more severe events (hematologic, diarrhea, and number of days hospitalized) occurring in group B.
Platinum plus paclitaxel or platinum plus irinotecan provided similar OS in community patients, although patients receiving irinotecan experienced more severe events. In the adenocarcinoma population, a fluoropyrimidine plus platinum-based regimen, although less frequently used, had a more favorable toxicity profile, with superior median OS and disease control.
尽管食管癌和胃癌在流行病学及分子层面存在差异，但大多数已发表的研究纳入的转移性患者中既有食管癌患者也有胃癌患者。我们评估了社区环境下转移性食管癌患者化疗的安全性和有效性。
我们对2008年至2016年期间在一家公立医院接受同步转移性食管癌治疗的患者进行了一项回顾性队列研究。患者根据规定的化疗方案分组：铂类和紫杉烷（A组）；铂类和伊立替康（B组）；铂类和氟嘧啶（C组）；以及不含铂类（D组）。
在接受治疗的1789例食管癌患者中，我们纳入了397例初诊时即有转移性疾病的患者。鳞状细胞癌是最常见的组织学类型（78.8%）。中位总生存期（OS）为7个月（95%置信区间，6.15至7.85个月）。285例患者接受了化疗，其达到的中位OS为9.0个月（95%置信区间，8.0至9.9个月）；对于112例未接受治疗的患者，中位OS为3个月（95%置信区间，2.3至3.7个月；P<0.001）。最常用的联合方案是铂类加伊立替康（A组；55.5%）。A、B、C和D组的疾病控制率分别为39.2%、30.1%、53%和14.3%。C组患者的中位OS达到17个月（95%置信区间，13.1至20.8个月；P = 0.034）。使用其他方案获得的中位OS（9个月）未观察到差异。毒性特征因化疗而异，B组发生更严重的事件（血液学、腹泻和住院天数）。
铂类加紫杉醇或铂类加伊立替康在社区患者中提供了相似的总生存期，尽管接受伊立替康治疗的患者经历了更严重的事件。在腺癌患者群体中，氟嘧啶加铂类方案虽然使用频率较低，但其毒性特征更有利，中位总生存期和疾病控制效果更佳。
