术后辅助化疗与放化疗治疗淋巴结阳性食管鳞癌的比较：倾向评分匹配分析。
Postoperative adjuvant chemotherapy versus chemoradiotherapy for node-positive esophageal squamous cell carcinoma: a propensity score-matched analysis.
机构信息
Department of Radiation Oncology,Sichuan Cancer Hospital & Institution, Sichuan Cancer Center, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, 610041, China.
Department of Medical Oncology,Sichuan Cancer Hospital & Institution, Sichuan Cancer Center, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, 610041, China.
出版信息
Radiat Oncol. 2020 May 24;15(1):119. doi: 10.1186/s13014-020-01557-9.
BACKGROUND AND PURPOSE
After esophagectomy, adjuvant chemotherapy (S + CT) and adjuvant chemoradiotherapy (S + CRT) can improve survival in patients with node-positive resectable esophageal cancer. However, we are not aware of any studies that directly compared these adjuvant treatments. This study aimed to compare S + CT and S + CRT for patients with esophageal cancer.
MATERIALS AND METHODS
We retrospectively identified patients with node-positive esophageal squamous cell carcinoma who underwent S + CT or S + CRT at Sichuan Cancer Hospital during 2008-2017. The patients' characteristics were compared, as well as their overall survival (OS) and disease-free survival (DFS) outcomes. Propensity score matching was used to create balanced patient groups according to adjuvant treatment, and a Cox proportional hazards model was used to identify factors that predicted the survival outcomes.
RESULTS
The 859 eligible patients underwent S + CRT (250 patients, 29.1%) or S + CT (609 patients, 70.9%). After propensity score matching (247 patients per group), the 5-year OS rates were 41.8% for S + CRT and 26.8% for S + CT (p = 0.028), and the 5-year DFS rates were 37.2% for S + CRT and 25.5% for S + CT (p = 0.012). Multivariate Cox regression analysis of the matched samples revealed that, relative to the S + CT group, the S + CRT group had better OS (hazard ratio: 0.71, 95% CI: 0.56-0.91; p = 0.006) and DFS (hazard ratio: 0.70, 95% CI: 0.56-0.88; p = 0.002).
CONCLUSION
Among patients with node-positive resectable esophageal squamous cell carcinoma, S + CRT was associated with better OS than S + CT. A multicenter randomized clinical trial is warranted to confirm these findings.
背景与目的
食管切除术（esophagectomy）后，辅助化疗（adjuvant chemotherapy，S+CT）和辅助放化疗（adjuvant chemoradiotherapy，S+CRT）可提高淋巴结阳性可切除食管癌患者的生存率。然而，我们尚未发现任何直接比较这些辅助治疗的研究。本研究旨在比较 S+CT 和 S+CRT 对食管癌患者的疗效。
材料与方法
我们回顾性分析了 2008 年至 2017 年在四川省肿瘤医院接受 S+CT 或 S+CRT 的淋巴结阳性食管鳞癌患者。比较了患者特征以及总生存（overall survival，OS）和无病生存（disease-free survival，DFS）结局。采用倾向评分匹配（propensity score matching，PSM）根据辅助治疗方法创建均衡的患者组，并采用 Cox 比例风险模型确定预测生存结局的因素。
结果
859 例符合条件的患者接受了 S+CRT（250 例，29.1%）或 S+CT（609 例，70.9%）。进行 PSM（每组 247 例）后，S+CRT 的 5 年 OS 率为 41.8%，S+CT 为 26.8%（p=0.028），S+CRT 的 5 年 DFS 率为 37.2%，S+CT 为 25.5%（p=0.012）。对匹配样本的多变量 Cox 回归分析显示，与 S+CT 组相比，S+CRT 组 OS 更好（风险比：0.71，95%置信区间：0.56-0.91；p=0.006），DFS 更好（风险比：0.70，95%置信区间：0.56-0.88；p=0.002）。
结论
在淋巴结阳性可切除食管鳞癌患者中，S+CRT 与 S+CT 相比，OS 更好。需要开展多中心随机临床试验来证实这些发现。
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