Department of Radiation Oncology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan.
Division of Thoracic Surgery, Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan.
BMC Gastroenterol. 2021 Apr 7;21(1):153. doi: 10.1186/s12876-021-01742-4.
The role of radiotherapy for cT4bNanyM0 esophageal squamous cell carcinoma (ESqCC) is relatively unclear, with both chemotherapy (C/T) alone and definitive concurrent chemoradiotherapy (dCCRT) being treatment options in the current guidelines. We aimed to compare the survival of dCCRT versus C/T for these patients via a population-based approach.
Eligible cT4b ESqCC patients diagnosed between 2011 and 2017 were identified via the Taiwan Cancer Registry. We used propensity score (PS) weighting to balance the observable potential confounders between groups. The hazard ratio (HR) of death and incidence of esophageal cancer mortality (IECM) were compared between dCCRT and C/T. We also evaluated OS in subgroups of either low or standard radiotherapy doses.
Our primary analysis consisted of 247 patients in whom covariates were well balanced after PS weighing. The HR for death when dCCRT was compared with C/T was 0.36 (95% confidence interval 0.24-0.53, P < 0.001). Similar results were found for IECM. Statistical significance was only observed in the standard RT dose but not in the low dose in subgroup analyses.
In this population-based nonrandomized study of cT4bNanyM0 ESqCC patients from Asia (Taiwan), we found that the use of radiotherapy with chemotherapy was associated with better overall survival than chemotherapy alone. Further studies (especially RCTs) are needed to confirm our findings.
对于 cT4bNanyM0 食管鳞状细胞癌（ESqCC）患者，放疗的作用尚不清楚，目前的指南中同时推荐单独化疗（C/T）和根治性同步放化疗（dCCRT）。我们旨在通过基于人群的方法比较 dCCRT 与 C/T 对这些患者的生存影响。
通过台湾癌症登记处，确定了 2011 年至 2017 年间诊断的 cT4b ESqCC 患者。我们使用倾向评分（PS）加权来平衡组间可观察到的潜在混杂因素。比较 dCCRT 与 C/T 组的死亡风险比（HR）和食管癌死亡率（IECM）。我们还评估了低剂量或标准剂量放疗亚组的 OS。
我们的主要分析包括 247 例患者，这些患者在 PS 加权后协变量得到了很好的平衡。与 C/T 相比，dCCRT 的死亡 HR 为 0.36（95%置信区间 0.24-0.53，P<0.001）。对于 IECM 也得到了类似的结果。仅在标准 RT 剂量亚组中观察到统计学意义，而在低剂量亚组中则没有。
在这项来自亚洲（台湾）的 cT4bNanyM0 ESqCC 患者的基于人群的非随机研究中，我们发现与单独化疗相比，化疗联合放疗可改善总生存。需要进一步的研究（特别是 RCT）来证实我们的发现。
