Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA.
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, Guangdong Province, China.
Dis Esophagus. 2020 Apr 15;33(4). doi: 10.1093/dote/doz073.
In efforts to better characterize incidence and predictors of 30- and 90-day mortality following operative versus nonoperative approaches for locally advanced esophageal cancer (EC), we conducted a novel investigation of a large, contemporary US database. The National Cancer Database was queried for newly-diagnosed T1-3N0-1 squamous cell or adenocarcinoma receiving surgical-based therapy (esophagectomy alone or preceded by chemotherapy and/or radiotherapy) versus definitive chemoradiotherapy (dCRT). Statistics included graphing cumulative incidences of mortality before and following propensity score matching (PSM), based on age-based intervals. Cox regression determined factors independently predictive of 30- and 90-day mortality. Of 15,585 patients, 9,278 (59.5%) received surgical-based therapy and 6,307 (40.5%) underwent dCRT. In the unadjusted population, despite nonsignificant differences at 30 days (3.3% dCRT, 3.6% surgical-based), the dCRT cohort experienced higher 90-day mortality (11.0% vs. 7.5%, P < 0.001). Following PSM, however, dCRT patients experienced significantly lower 30-day mortality (P < 0.001), with nonsignificant differences at 90 days (P = 0.092). Surgical-based management yielded similar (or better) mortality as dCRT in ≤70-year-old patients; however, dCRT was associated with reduced mortality in subjects > 70 years old. In addition to the intervention group, factors predictive for 30- and 90-day mortality included age, gender, insurance status, facility type, comorbidity index, tumor location, histology, and T/N classification. In summary, surgical-based therapy for EC is associated with higher 30-day mortality, which becomes statistically similar to dCRT by 90 days. Differences between surgery and dCRT were most pronounced in patients > 70 years of age. These data may better inform shared decision-making between multidisciplinary providers and patients.
为了更好地描述局部晚期食管癌（EC）手术与非手术治疗后 30 天和 90 天死亡率的发生率和预测因素，我们对一个大型的当代美国数据库进行了一项新的研究。国家癌症数据库被查询了新诊断的 T1-3N0-1 鳞状细胞癌或腺癌患者，这些患者接受了基于手术的治疗（单纯食管切除术或化疗和/或放疗前）或确定性放化疗（dCRT）。统计分析包括根据年龄间隔，在倾向评分匹配（PSM）前后绘制死亡率的累积发生率图。Cox 回归确定了 30 天和 90 天死亡率的独立预测因素。在 15585 名患者中，9278 名（59.5%）接受了基于手术的治疗，6307 名（40.5%）接受了 dCRT。在未调整的人群中，尽管 30 天的差异无统计学意义（dCRT 为 3.3%，基于手术的为 3.6%），但 dCRT 组的 90 天死亡率更高（11.0%比 7.5%，P<0.001）。然而，经过 PSM 后，dCRT 患者的 30 天死亡率显著降低（P<0.001），90 天死亡率无显著差异（P=0.092）。在≤70 岁的患者中，手术治疗与 dCRT 的死亡率相似（或更低）；然而，在>70 岁的患者中，dCRT 与死亡率降低相关。除了干预组，30 天和 90 天死亡率的预测因素还包括年龄、性别、保险状况、机构类型、合并症指数、肿瘤位置、组织学和 T/N 分类。总之，EC 的基于手术的治疗与较高的 30 天死亡率相关，在 90 天内与 dCRT 的统计学相似。手术与 dCRT 之间的差异在>70 岁的患者中最为明显。这些数据可能更好地为多学科提供者和患者之间的共同决策提供信息。
