新辅助化疗后放疗在可手术切除食管癌中的应用。
Utility of Radiation After Neoadjuvant Chemotherapy for Surgically Resectable Esophageal Cancer.
机构信息
Department of Surgery, North Florida Regional Medical Center, University of Central Florida College of Medicine, Gainesville, FL, USA.
Department of Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
出版信息
Ann Surg Oncol. 2020 Mar;27(3):662-670. doi: 10.1245/s10434-019-07788-9. Epub 2019 Dec 1.
INTRODUCTION
Neoadjuvant chemotherapy (NAC) ± radiation (NRT) is the "gold standard" approach for locally advanced esophageal cancer (EC). However, the benefits of RT on overall survival (OS) in patients with resectable EC undergoing neoadjuvant therapy followed by esophagectomy remain controversial.
METHODS
The National Cancer Data Base was queried for patients with nonmetastatic EC between 2004 and 2014. Kaplan-Meier, log-rank, and Cox multivariable regression analysis were performed to analyze OS. Logistic regression analyzed factors associated with 90-day mortality, lymph node involvement, and complete pathological response (pCR).
RESULTS
A total of 12,238 EC patients who underwent neoadjuvant therapy [neoadjuvant chemoradiation (NACR), 92.1% and NAC, 7.9%] followed by esophagectomy were included. OS was similar in patients undergoing NAC ± RT (35.9 vs. 37.6 mo, respectively, p = 0.393). pCR rate was 18.1% (19.2%, NACR vs. 6.3%, NAC, p < 0.001). NRT was an independent predictor for increased pCR (HR 2.593, p < 0.001). Patients with pCR had increased survival compared with those without pCR (62.3 vs. 34.4 mo, p < 0.001); however, no difference was found between NACR and NAC (61.7 mo vs. median not reached, p = 0.745) in pCR patients. In non-pCR patients, NAC had improved OS compared with NACR (37.3 vs. 30.8 mo, p = 0.002). NRT was associated with worse 90-day mortality (8.2% vs. 7.7%, HR1.872, p = 0.036) In Cox regression, NRT was an independent predictor of worse OS (HR 1.561, p < 0.001).
CONCLUSIONS
Neoadjuvant RT is associated with improved pCR rates; however, it had deleterious effects in short- and long-term survival. Also, patients who did not achieve pCR had worse OS after neoadjuvant RT.
简介
新辅助化疗（NAC）±放疗（NRT）是局部晚期食管癌（EC）的“金标准”治疗方法。然而，在接受新辅助治疗后行食管切除术的可切除 EC 患者中，RT 对总生存（OS）的获益仍存在争议。
方法
从 2004 年至 2014 年，国家癌症数据库对非转移性 EC 患者进行了查询。采用 Kaplan-Meier、对数秩检验和 Cox 多变量回归分析来分析 OS。Logistic 回归分析了与 90 天死亡率、淋巴结受累和完全病理缓解（pCR）相关的因素。
结果
共纳入 12238 例接受新辅助治疗[新辅助放化疗（NACR），92.1%；新辅助化疗（NAC），7.9%]后行食管切除术的 EC 患者。接受 NAC±RT 的患者 OS 相似（分别为 35.9 和 37.6 个月，p=0.393）。pCR 率为 18.1%（NACR 为 19.2%，NAC 为 6.3%，p<0.001）。NRT 是 pCR 增加的独立预测因素（HR 2.593，p<0.001）。与无 pCR 患者相比，有 pCR 的患者生存率更高（62.3 与 34.4 个月，p<0.001）；然而，在 pCR 患者中，NACR 和 NAC 之间没有差异（61.7 个月与未达到中位值，p=0.745）。在非 pCR 患者中，与 NACR 相比，NAC 可改善 OS（37.3 与 30.8 个月，p=0.002）。NRT 与 90 天死亡率增加相关（8.2%与 7.7%，HR1.872，p=0.036）。在 Cox 回归中，NRT 是 OS 不良的独立预测因素（HR 1.561，p<0.001）。
结论
新辅助 RT 可提高 pCR 率；然而，它对短期和长期生存有不利影响。此外，未达到 pCR 的患者在接受新辅助 RT 后 OS 更差。
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