Kim Bradford J, Chiang Yi-Ju, Das Prajnan, Minsky Bruce D, Blum Mariela A, Ajani Jaffer A, Estrella Jeannelyn S, Hofstetter Wayne L, Tzeng Ching-Wei D, Badgwell Brian D, Mansfield Paul F, Ikoma Naruhiko
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Drive, Unit 1484, Houston, TX 77030, USA.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Drive, Unit 1484, Houston, TX 77030, USA.
J Clin Med. 2020 Oct 29;9(11):3495. doi: 10.3390/jcm9113495.
Despite the increasing incidence of gastroesophageal junction adenocarcinoma (GEJA), the optimal treatment strategy for the disease remains unknown. The objective of this study was to describe treatment patterns for GEJA in the United States. The National Cancer Database was searched to identify all patients who underwent resection of the lower esophagus, abdominal esophagus, and/or gastric cardia for GEJA between 2006 and 2016. Patients were grouped by clinical disease stage: early localized (L; T1-2N0), locally advanced (LA; T3-4N0), regional (R; T1-2N+), or regionally advanced (RA; T3-4N+). The search identified 28,852 GEJA patients. The dominant age range was 60-69 years (39%). Most patients were men (85%), and most were white (92%). Most L patients (69%) underwent upfront surgery, whereas most LA, R, and RA patients received neoadjuvant therapy (NAT; 86%, 80%, and 90%, respectively). Among patients who received NAT, 85% received chemoradiotherapy. Adjuvant therapy was relatively uncommon across all groups (15-20%). In the LA, R, and RA groups, overall survival was greater in patients who received NAT compared to upfront surgery ( < 0.001). With the exception of patients with early localized node-negative disease, most GEJA patients receive neoadjuvant chemoradiotherapy despite the lack of prospective trials reporting survival benefit over chemotherapy alone.
尽管胃食管交界腺癌（GEJA）的发病率不断上升，但该病的最佳治疗策略仍不明确。本研究的目的是描述美国GEJA的治疗模式。检索国家癌症数据库，以确定2006年至2016年间因GEJA接受下食管、腹段食管和/或贲门切除术的所有患者。患者按临床疾病分期分组：早期局限性（L；T1-2N0）、局部进展期（LA；T3-4N0）、区域期（R；T1-2N+）或区域进展期（RA；T3-4N+）。检索共识别出28852例GEJA患者。主要年龄范围为60-69岁（39%）。大多数患者为男性（85%），且大多数为白人（92%）。大多数L期患者（69%）接受了 upfront手术，而大多数LA、R和RA期患者接受了新辅助治疗（NAT；分别为86%、80%和90%）。在接受NAT的患者中，85%接受了放化疗。辅助治疗在所有组中相对不常见（15%-20%）。在LA、R和RA组中，接受NAT的患者总生存期高于接受 upfront手术的患者（P<0.001）。除早期局限性淋巴结阴性疾病患者外，大多数GEJA患者接受新辅助放化疗尽管缺乏前瞻性试验报告其生存获益优于单纯化疗。
