Drake Justin, Tauer Kurt, Portnoy David, Weksler Benny
Division of Thoracic Surgery, Department of Surgery, University of Tennessee Health Science Center, and West Cancer Center, Memphis, TN, USA.
Division of Medical Oncology, Department of Medicine, University of Tennessee Health Science Center, and West Cancer Center, Memphis, TN, USA.
J Thorac Dis. 2019 Jun;11(6):2546-2554. doi: 10.21037/jtd.2019.05.66.
Studies supporting adjuvant chemotherapy after complete resection of esophageal cancer are scarce, and current clinical guidelines recommend either adjuvant chemotherapy or observation. We aimed to clarify the role of adjuvant chemotherapy in patients found to have persistent nodal metastases after neoadjuvant chemoradiation and complete resection of esophageal adenocarcinoma.
We queried the National Cancer Database (NCDB) for all patients from 2006 to 2012 with esophageal adenocarcinoma who received neoadjuvant chemoradiotherapy, underwent esophagectomy with complete resection, and were found to have lymph node metastases on final pathology. We compared patients who received adjuvant chemotherapy with patients followed by observation only. After performing propensity-score matching to create a well-balanced cohort, we compared survival using the Kaplan-Meier method.
We identified 2,046 patients with lymph node metastases after neoadjuvant chemoradiotherapy and esophagectomy; 295 received adjuvant chemotherapy, and 1,751 did not. The median survival in the unmatched cohort was 2.6 years with adjuvant chemotherapy and 2.1 years with observation only (P=0.0185). Five-year survival was 27.9% with adjuvant chemotherapy and 21.5% with observation only. When we examined survival in a balanced cohort of 295 propensity-matched pairs, median survival was 2.6 years with adjuvant chemotherapy and 2.0 years with observation only (P=0.031). Five-year survival was 27.9% with adjuvant chemotherapy and 20.2% with observation only.
In a large, propensity-matched cohort, adjuvant chemotherapy was associated with significantly improved survival for patients with node-positive esophageal adenocarcinoma after neoadjuvant therapy and complete resection. This finding supports the use of adjuvant therapy for patients with node-positive adenocarcinoma after neoadjuvant therapy and surgery.
支持食管癌完全切除术后辅助化疗的研究较少，目前的临床指南推荐辅助化疗或观察。我们旨在阐明辅助化疗在新辅助放化疗及食管腺癌完全切除术后发现有持续性淋巴结转移患者中的作用。
我们查询了国家癌症数据库（NCDB）中2006年至2012年所有接受新辅助放化疗、行食管切除术且最终病理发现有淋巴结转移的食管腺癌患者。我们将接受辅助化疗的患者与仅接受观察的患者进行比较。在进行倾向评分匹配以创建一个均衡的队列后，我们使用Kaplan-Meier方法比较生存率。
我们确定了2046例新辅助放化疗及食管切除术后有淋巴结转移的患者；295例接受辅助化疗，1751例未接受。在未匹配的队列中，辅助化疗组的中位生存期为2.6年，仅观察组为2.1年（P = 0.0185）。辅助化疗组的5年生存率为27.9%，仅观察组为21.5%。当我们在295对倾向匹配的均衡队列中检查生存率时，辅助化疗组的中位生存期为2.6年，仅观察组为2.0年（P = 0.031）。辅助化疗组的5年生存率为27.9%，仅观察组为20.2%。
在一个大型的、倾向匹配的队列中，辅助化疗与新辅助治疗及完全切除术后淋巴结阳性食管腺癌患者的生存率显著提高相关。这一发现支持对新辅助治疗及手术后淋巴结阳性腺癌患者使用辅助治疗。
