Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.
Department of Esophageal Cancer, Tianjin's Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
Thorac Cancer. 2020 Oct;11(10):2820-2829. doi: 10.1111/1759-7714.13607. Epub 2020 Aug 12.
This study investigated the prognostic impact of (neo-)adjuvant radiation therapies in early stage esophageal cancer.
A retrospective analysis using the Surveillance, Epidemiology, and End Results (SEER) database was conducted from 2004 to 2016. Patients with pathologically staged T1-4N0M0 esophageal cancer were divided into two treatment groups: (i) neoadjuvant radiotherapy followed by surgery; and (ii) upfront esophagectomy followed by adjuvant radiotherapy. Propensity scored match and Cox proportional hazards model were used to identify covariates associated with overall survival and cancer-specific survival.
There were 821 patients selected, of whom 588 (71.6%) received neoadjuvant radiotherapy and 233 (28.4%) received adjuvant radiotherapy. For the entire cohort, neoadjuvant radiotherapy was associated with a significantly benefit in five-year survival outcomes compared with adjuvant radiotherapy (P < 0.01). After matching, the survival outcomes were still better for neoadjuvant radiotherapy than that of adjuvant treatment. Stratifying based on pathologic tumor status, neoadjuvant radiation was associated with improved CSS (five-year survival 73.7% vs. 42.1%; P = 0.014) for localized (pT3-4N0) disease. The Cox multivariate regression analysis revealed that the addition of neoadjuvant radiation for pT3-4N0 diseases with tumor length ≥ 5 cm and squamous cell carcinoma, was a powerful prognostic factor for improved cancer-specific survival (P < 0.01).
Compared with adjuvant radiotherapy, the addition of neoadjuvant radiation for pT3-4N0 diseases has been associated with improved cancer-specific survival in high-risk patients. Studies on preoperative neoadjuvant therapies would be plausible in high-risk esophageal cancer patients.
本研究旨在探讨（新）辅助放疗对早期食管癌的预后影响。
本研究采用回顾性分析方法，使用 2004 年至 2016 年期间的监测、流行病学和最终结果（SEER）数据库。将经病理分期为 T1-4N0M0 的食管癌患者分为两组：（i）新辅助放疗后手术；（ii）根治性手术，术后辅助放疗。采用倾向评分匹配和 Cox 比例风险模型来确定与总生存期和癌症特异性生存期相关的协变量。
共纳入 821 例患者，其中 588 例（71.6%）接受新辅助放疗，233 例（28.4%）接受辅助放疗。在整个队列中，与辅助放疗相比，新辅助放疗在五年生存结局方面具有显著优势（P < 0.01）。匹配后，新辅助放疗的生存结局仍优于辅助治疗。根据病理肿瘤状态分层，新辅助放疗与局部（pT3-4N0）疾病的 CSS 改善相关（五年生存率为 73.7% vs. 42.1%；P = 0.014）。Cox 多因素回归分析显示，对于肿瘤长度≥5cm 和鳞状细胞癌的 pT3-4N0 疾病，新辅助放疗的加入是提高癌症特异性生存率的有力预后因素（P < 0.01）。
与辅助放疗相比，对于 pT3-4N0 疾病，新辅助放疗的加入与高危患者的癌症特异性生存率提高相关。对于高危食管癌患者，术前新辅助治疗的研究可能是合理的。
