Department of Medical Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
Department of Radiology, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, Anhui Province, China.
Cancer Med. 2019 Dec;8(17):7253-7264. doi: 10.1002/cam4.2609. Epub 2019 Oct 14.
We aimed to explore the value of palliative resection or radiation of primary tumor for metastatic esophageal cancer (EC) patients.
Surveillance, Epidemiology, and End Results database was used for identifying metastatic EC patients. The patients were divided into resection and nonresection groups. And patients without resection were divided into radiation and nonradiation groups. Propensity score matching (PSM) analyses were adopted to reduce the baseline differences between the groups. Cancer specific survivals (CSSs) and overall survivals (OSs) were compared by Kaplan-Meier (K-M) curves. Multivariable analyses by COX proportion hazards model were performed to identify risk factors for CSS and OS. Predictive nomograms were conducted according to both postoperative factors and preoperative factors.
A total of 7982 metastatic EC patients were selected for our analyses. After PSM, 978 patients were included in the survival analyses comparing palliative resection and nonresection. The CSS and OS for patients underwent palliative resection were significantly longer than those without resection (median CSS: 21 months vs 7 months, P < .001; median OS: 20 months vs 7 months, P < .001). In the overall population without resection, 654 patients were matched for radiation and nonradiation groups. And K-M curves showed that patients with radiation had longer CSS and OS than those without radiation (median CSS: 11 months vs 6 months, P < .001; median OS: 10 months vs 6 months, P < .001). Nomograms were generated for prediction of 1-, 2-, and 3-year CSS and OS. All C-indexes implied moderate discrimination and accuracy. And all nomograms had good calibration.
Palliative resection or radiation of primary tumor could prolong CSS and OS of metastatic EC patients.
本研究旨在探讨姑息性原发肿瘤切除术或放疗对转移性食管癌（EC）患者的价值。
本研究利用监测、流行病学和最终结果数据库（SEER）确定转移性 EC 患者。将患者分为切除术组和非切除术组。非切除术组患者进一步分为放疗组和非放疗组。采用倾向评分匹配（PSM）分析以减少组间基线差异。采用 Kaplan-Meier（K-M）曲线比较两组的癌症特异性生存率（CSS）和总生存率（OS）。采用 COX 比例风险模型多变量分析确定 CSS 和 OS 的危险因素。根据术后和术前因素构建预测列线图。
共纳入 7982 例转移性 EC 患者进行分析。经 PSM 后，978 例患者纳入姑息性切除术与非切除术生存分析。姑息性切除术患者的 CSS 和 OS 明显长于非切除术患者（中位 CSS：21 个月比 7 个月，P<0.001；中位 OS：20 个月比 7 个月，P<0.001）。在非切除术总体人群中，654 例患者按放疗和非放疗进行匹配。K-M 曲线显示，放疗组患者的 CSS 和 OS 长于非放疗组（中位 CSS：11 个月比 6 个月，P<0.001；中位 OS：10 个月比 6 个月，P<0.001）。构建了预测 1、2 和 3 年 CSS 和 OS 的列线图。所有 C 指数均提示具有中度判别能力和准确性。所有列线图均具有良好的校准度。
姑息性原发肿瘤切除术或放疗可延长转移性 EC 患者的 CSS 和 OS。
