Yang Ying, Jia Jun, Sun Zhiwei, Liu Chuanling, Xiao Yanjie, Yu Jing, Du Feng, Zhang Xiaodong
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, China), The VIP-II Gastrointestinal Cancer Division of Medical Department, Peking University Cancer Hospital & Institute, Beijing, China.
Cancer Manag Res. 2020 Mar 24;12:2177-2184. doi: 10.2147/CMAR.S242780. eCollection 2020.
Esophageal squamous cell carcinoma (ESCC) is a critical threat to health and life. More than half of ESCC patients have recurrent or metastatic disease. Most late-stage patients undergo first-line treatment but experience further progression. Many of these patients have good performance status and are able to receive second-line therapy and even further treatments rather than best supportive care. Our analysis aimed to explore whether multiple lines of active treatment are beneficial in ESCC patients.
We conducted a retrospective cohort study. Univariate and multivariate survival analyses were used to identify whether the number of active treatment lines was related to prognosis. All analyses and the corresponding survival curves were based on the Cox proportional hazard regression model and the Kaplan-Meier method. Comparisons between groups were conducted using the -test, chi-square test, and Fisher's exact test, as applicable.
Of a total of 138 patients with recurrent or metastatic disease, 66 (61.1%) received one line of active treatment, and 42 (38.9%) patients received two and more lines. Multiple lines of active therapy were statistically significantly associated with better prognosis (crude hazard ratio (HR) (95% confidence interval (CI))=0.21 (0.06-0.73)), even after adjusting for relevant confounders (adjusted HR (95% CI)=0.19 (0.04-0.86)). More grade 3-4 hepatotoxicity patients were observed in the multiple-line treatment group (p=0.033). A small number of patients were cured by palliative management; these patients were more likely to have received both systematic and local treatment than other patients with repeated progression (9/15 versus 40/117, p=0.051).
Multiple lines of active treatment are related to prolonged survival in recurrent and metastatic ESCC patients, and adverse effects are acceptable. Comprehensive therapy modalities are recommended.
食管鳞状细胞癌（ESCC）对健康和生命构成重大威胁。超过半数的ESCC患者会出现复发或转移性疾病。大多数晚期患者接受一线治疗，但病情会进一步进展。这些患者中有许多身体状况良好，能够接受二线治疗甚至更多线治疗，而不是最佳支持治疗。我们的分析旨在探讨多线积极治疗对ESCC患者是否有益。
我们进行了一项回顾性队列研究。采用单因素和多因素生存分析来确定积极治疗线数是否与预后相关。所有分析及相应的生存曲线均基于Cox比例风险回归模型和Kaplan-Meier方法。组间比较根据适用情况使用t检验、卡方检验和Fisher精确检验。
在总共138例复发或转移性疾病患者中，66例（61.1%）接受了一线积极治疗，42例（38.9%）患者接受了两线及以上治疗。多线积极治疗在统计学上与更好的预后显著相关（粗风险比（HR）（95%置信区间（CI））=0.21（0.06 - 0.73）），即使在调整相关混杂因素后（调整后HR（95%CI）=0.19（0.04 - 0.86））。多线治疗组中观察到更多3 - 4级肝毒性患者（p = 0.033）。少数患者通过姑息治疗治愈；这些患者比其他反复进展的患者更有可能接受了全身和局部治疗（9/15对40/117，p = 0.051）。
多线积极治疗与复发和转移性ESCC患者的生存期延长相关，且不良反应可接受。建议采用综合治疗模式。
