Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
Ann Surg. 2022 Feb 1;275(2):348-355. doi: 10.1097/SLA.0000000000003886.
Determine whether adjuvant chemotherapy is associated with a survival benefit in high risk T2-4a, pathologically node-negative distal esophageal adenocarcinoma.
There is minimal literature to substantiate the NCCN guidelines recommending adjuvant therapy for patients with distal esophageal adenocarcinoma and no pathologic evidence of nodal disease.
The National Cancer Database was used to identify adult patients with pT2-4aN0M0 esophageal adenocarcinoma who underwent definitive surgery (2004-2015) and had characteristics considered high risk by the NCCN. Patients were stratified by receipt of adjuvant chemotherapy with or without radiation. The primary outcome was overall survival, which was evaluated using Kaplan-Meier and multivariable Cox Proportional Hazards models. A 1:1 propensity score-matched analysis was also performed to compare survival between the groups.
Four hundred three patients met study criteria: 313 (78%) without adjuvant therapy and 90 who received adjuvant chemotherapy with or without radiation (22%). In both unadjusted and multivariable analysis, adjuvant chemotherapy with or without radiation was not associated with a significant survival benefit compared to no adjuvant therapy. In a subgroup analysis of 335 patients without high risk features by NCCN criteria, adjuvant chemotherapy was not independently associated with a survival benefit.
In this analysis, adjuvant chemotherapy with or without radiation was not associated with a significant survival benefit in completely resected, pathologically node-negative distal esophageal adenocarcinoma, independent of presence of high risk characteristics. The risks and benefits of adjuvant therapy should be weighed before offering it to patients with completely resected pT2-4aN0M0 esophageal adenocarcinoma.
确定辅助化疗是否与高危 T2-4a、病理淋巴结阴性远端食管腺癌患者的生存获益相关。
几乎没有文献可以证实 NCCN 指南建议对无病理淋巴结疾病证据的远端食管腺癌患者进行辅助治疗。
使用国家癌症数据库确定接受根治性手术（2004-2015 年）且具有 NCCN 认为的高危特征的 pT2-4aN0M0 食管腺癌成年患者。患者根据是否接受辅助化疗联合或不联合放疗进行分层。主要结局是总生存，使用 Kaplan-Meier 和多变量 Cox 比例风险模型进行评估。还进行了 1:1 倾向评分匹配分析，以比较两组之间的生存情况。
403 名患者符合研究标准：313 名（78%）未接受辅助治疗，90 名接受辅助化疗联合或不联合放疗（22%）。在未调整和多变量分析中，与未接受辅助治疗相比，辅助化疗联合或不联合放疗均与生存获益无显著相关性。在 NCCN 标准无高危特征的 335 名患者的亚组分析中，辅助化疗与生存获益也无独立相关性。
在这项分析中，对于完全切除、病理淋巴结阴性的远端食管腺癌患者，无论是否存在高危特征，辅助化疗联合或不联合放疗均与生存获益无显著相关性。在为完全切除的 pT2-4aN0M0 食管腺癌患者提供辅助治疗之前，应权衡其风险和获益。
