新辅助放化疗与单纯化疗治疗食管癌：基于人群的队列研究。
Neoadjuvant chemoradiotherapy or chemotherapy alone for oesophageal cancer: population-based cohort study.
机构信息
Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle University Trust Hospitals, Newcastle upon Tyne, UK.
Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
出版信息
Br J Surg. 2021 Apr 30;108(4):403-411. doi: 10.1093/bjs/znaa121.
BACKGROUND
Although both neoadjuvant chemoradiotherapy (nCRT) and chemotherapy (nCT) are used as neoadjuvant treatment for oesophageal cancer, it is unknown whether one provides a survival advantage over the other, particularly with respect to histological subtype. This study aimed to compare prognosis after nCRT and nCT in patients undergoing oesophagectomy for oesophageal adenocarcinoma (OAC) or squamous cell carcinoma (OSCC).
METHODS
Data from the National Cancer Database (2006-2015) were used to identify patients with OAC and OSCC. Propensity score matching and Cox multivariable analyses were used to account for treatment selection biases.
RESULTS
The study included 11 167 patients with OAC (nCRT 9972, 89.3 per cent; nCT 1195, 10.7 per cent) and 2367 with OSCC (nCRT 2155, 91.0 per cent; nCT 212, 9.0 per cent). In the matched OAC cohort, nCRT provided higher rates of complete pathological response (35.1 versus 21.0 per cent; P < 0.001) and margin-negative resections (90.1 versus 85.9 per cent; P < 0.001). However, patients who had nCRT had similar survival to those who received nCT (hazard ratio (HR) 1.04, 95 per cent c.i. 0.95 to 1.14). Five-year survival rates for patients who had nCRT and nCT were 36 and 37 per cent respectively (P = 0.123). For OSCC, nCRT had higher rates of complete pathological response (50.9 versus 30.4 per cent; P < 0.001) and margin-negative resections (92.8 versus 82.4 per cent; P < 0.001). A statistically significant overall survival benefit was evident for nCRT (HR 0.78, 0.62 to 0.97). Five-year survival rates for patients who had nCRT and nCT were 45.0 and 38.0 per cent respectively (P = 0.026).
CONCLUSION
Despite pathological benefits, including primary tumour response to nCRT, there was no prognostic benefit of nCRT compared with nCT for OAC suggesting that these two modalities are equally acceptable. However, for OSCC, nCRT followed by surgery appears to remain the optimal treatment approach.
背景
新辅助放化疗（nCRT）和化疗（nCT）均被用于食管癌的新辅助治疗，但尚不清楚两者中哪一种在生存方面具有优势，尤其是在组织学亚型方面。本研究旨在比较接受食管癌切除术的食管腺癌（OAC）或鳞状细胞癌（OSCC）患者接受 nCRT 和 nCT 后的预后。
方法
利用国家癌症数据库（2006-2015 年）的数据，确定 OAC 和 OSCC 患者。采用倾向评分匹配和 Cox 多变量分析来纠正治疗选择偏倚。
结果
本研究纳入了 11167 例 OAC 患者（nCRT 9972 例，89.3%；nCT 1195 例，10.7%）和 2367 例 OSCC 患者（nCRT 2155 例，91.0%；nCT 212 例，9.0%）。在匹配的 OAC 队列中，nCRT 组完全病理缓解率（35.1%比 21.0%；P<0.001）和切缘阴性率（90.1%比 85.9%；P<0.001）更高。然而，接受 nCRT 的患者与接受 nCT 的患者的生存情况相似（风险比 1.04，95%置信区间 0.95 至 1.14）。接受 nCRT 和 nCT 的患者的 5 年生存率分别为 36%和 37%（P=0.123）。对于 OSCC，nCRT 组完全病理缓解率（50.9%比 30.4%；P<0.001）和切缘阴性率（92.8%比 82.4%；P<0.001）更高。nCRT 具有显著的总生存获益（风险比 0.78，0.62 至 0.97）。接受 nCRT 和 nCT 的患者的 5 年生存率分别为 45.0%和 38.0%（P=0.026）。
结论
尽管 nCRT 具有病理获益，包括原发肿瘤对 nCRT 的反应，但与 nCT 相比，nCRT 对 OAC 并没有预后优势，这表明这两种方法同样可以接受。然而，对于 OSCC，nCRT 后手术似乎仍然是最佳的治疗方法。
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