Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Ann Thorac Surg. 2020 Aug;110(2):398-405. doi: 10.1016/j.athoracsur.2020.03.024. Epub 2020 Apr 11.
The incidence of lower esophageal and gastroesophageal junction adenocarcinoma has sharply increased over the past several decades and is a serious public health problem. Preoperative therapy with either chemotherapy or chemoradiation is recommended, but the optimal regimen is unknown. We used the National Cancer Database and propensity score matching to investigate whether preoperative chemoradiation therapy offers an advantage over chemotherapy alone for patients with these tumors.
From the National Cancer Database esophageal and gastric dataset, we selected patients with either lower esophageal or gastric cardia adenocarcinomas who had undergone definitive resection after chemotherapy or chemoradiation. We used propensity score matching to balance groups based on the preoperative treatment they received. We then used conditional multivariable logistic regression and Cox proportional hazard models to examine the association between preoperative therapy regimen and pathological response, overall survival (OS), and postoperative outcomes.
Our study included 13,783 patients; 12,129 (89.0%) had received preoperative chemoradiation. Propensity score matching created 1650 pairs. Patients receiving chemoradiation were 2.7 (95% confidence interval, 1.29-3.23) times more likely to achieve complete response in the primary tumor than were those receiving chemotherapy alone; however, chemoradiation was not associated with improved OS (hazard ratio, 1.01; 95% confidence interval, 0.91-1.12). Short-term outcomes (length of stay, mortality, and readmissions) were similar between the 2 groups.
Preoperative chemoradiation was associated with a higher complete response rate in the primary tumor but not with improved OS in lower esophageal and gastroesophageal junction adenocarcinoma.
在过去几十年中，食管下段和胃食管交界处腺癌的发病率急剧上升，这是一个严重的公共卫生问题。建议对这些肿瘤进行术前化疗或放化疗，但最佳方案尚不清楚。我们使用国家癌症数据库和倾向评分匹配来研究术前放化疗是否比单独化疗对这些肿瘤患者更有优势。
从国家癌症数据库的食管和胃数据集，我们选择了接受过化疗或放化疗后确定性切除的食管下段或贲门腺癌患者。我们使用倾向评分匹配根据接受的术前治疗来平衡组。然后，我们使用条件多变量逻辑回归和 Cox 比例风险模型来检查术前治疗方案与病理反应、总生存（OS）和术后结局之间的关联。
我们的研究纳入了 13783 名患者；12129 名（89.0%）接受了术前放化疗。倾向评分匹配创建了 1650 对。与单独接受化疗的患者相比，接受放化疗的患者在原发性肿瘤中完全缓解的可能性高 2.7 倍（95%置信区间，1.29-3.23）；然而，放化疗与改善 OS 无关（风险比，1.01；95%置信区间，0.91-1.12）。两组的短期结局（住院时间、死亡率和再入院率）相似。
术前放化疗与原发性肿瘤的完全缓解率较高相关，但与食管下段和胃食管交界处腺癌的 OS 改善无关。
