Zhang Wencheng, Zhao Jingjing, Han Weiming, Zhang Hualei, Wang Xin, Li Chen, Chen Junqiang, Wang Xiaomin, Zhao Yidian, Qiao Xueying, Zhou Zhiguo, Han Chun, Zhu Shuchai, Shen Wenbin, Wang Lan, Ge Xiaolin, Sun Xinchen, Zhang Kaixian, Hu Miaomiao, Li Ling, Hao Chongli, Li Gaofeng, Xu Yonggang, Wang Yadi, Lu Na, Liu Miaoling, Qian Shuai, Xiao Zefen, Wang Ping, Pang Qingsong
Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ann Transl Med. 2020 Sep;8(18):1140. doi: 10.21037/atm-20-4672.
To evaluate the impact of radiation dose escalation on overall survival (OS) in patients with non-metastatic esophageal squamous cell carcinoma (ESCC) treated with radical radiotherapy.
The clinical data of ESCC patients treated with three-dimensional (3D) radiotherapy alone or chemoradiotherapy were collected from multiple institutes and retrospectively analyzed. Patients who received radiation dose ≥40 Gy were included. Radiation dose as a continuous variable was entered into the Cox regression model by using penalized spline regression to allow for a nonlinear relationship between radiation dose and OS to be identified. Patients were stratified into five groups according to EQD. The Kaplan-Meier method was used to assess the OS in different dose groups. Univariate and multivariate analyses were performed to evaluate the factors associated with OS.
A total of 2,469 patients were included from 10 institutes across China. The median follow-up time was 58.3 months [95% confidence interval (CI): 56.4-60.2 months]. The median OS and PFS time were 24.3 months (95% CI: 22.5-26.2 months) and 18.0 months (95% CI: 16.4-19.6 months), respectively. The risk of death decreased sharply with a dose up to 60 to 62 Gy, before increasing slightly after the dose was elevated beyond 62 Gy. Multivariate analysis indicated that the chance of death was significantly decreased in patients who received radiotherapy doses of 60-62 Gy [P=0.028, hazard ratio (HR) 0.85, 95% CI: 0.73-0.98)], compared with those who received radiotherapy doses of 40-60 Gy.
Our results reveal radiation dose is a significant prognostic factor of survival for ESCC patients. Higher radiation dose contributes to much more favorable survival outcomes for ESCC patients receiving radical radiotherapy by modern techniques, and 60 Gy or above might be the most optimal radiation dose.
评估放射剂量增加对接受根治性放疗的非转移性食管鳞状细胞癌（ESCC）患者总生存期（OS）的影响。
收集多家机构单独接受三维（3D）放疗或放化疗的ESCC患者的临床资料，并进行回顾性分析。纳入接受放射剂量≥40 Gy的患者。将放射剂量作为连续变量通过惩罚样条回归纳入Cox回归模型，以确定放射剂量与OS之间的非线性关系。根据等效剂量（EQD）将患者分为五组。采用Kaplan-Meier法评估不同剂量组的OS。进行单因素和多因素分析以评估与OS相关的因素。
共纳入来自中国10家机构的2469例患者。中位随访时间为58.3个月[95%置信区间（CI）：56.4 - 60.2个月]。中位OS和无进展生存期（PFS）时间分别为24.3个月（95% CI：22.5 - 26.2个月）和18.0个月（95% CI：16.4 - 19.6个月）。剂量高达60至62 Gy时死亡风险急剧下降，剂量超过62 Gy后略有上升。多因素分析表明，与接受40 - 60 Gy放射剂量的患者相比，接受60 - 62 Gy放射剂量的患者死亡几率显著降低[P = 0.028，风险比（HR）0.85，95% CI：0.73 - 0.98]。
我们的结果表明放射剂量是ESCC患者生存的重要预后因素。更高的放射剂量有助于接受现代技术根治性放疗的ESCC患者获得更有利的生存结果，60 Gy及以上可能是最适宜的放射剂量。
