Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China.
Department of General Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
PLoS One. 2021 May 12;16(5):e0251555. doi: 10.1371/journal.pone.0251555. eCollection 2021.
To analyze the effect of neoadjuvant radiotherapy (nRT) on prognosis in patients with locoregional Siewert type II gastroesophageal junction adenocarcinoma (GEA).
All patients pathologically diagnosed as Siewert type II GEA between 2004 and 2015 were retrieved from the Surveillance, Epidemiology and Final Results (SEER) database. We analyzed the impact of different treatment regimens on the prognosis in each stage. Survival analysis was performed by Kaplan-Meier (K-M) method. Multivariate Cox model and propensity score matching was further used to verify the results.
4,160 patients were included in this study. The efficacy of nRT was superior to that of adjuvant radiotherapy (aRT) (p = 0.048), which was the same as that of surgery combined with chemotherapy (p = 0.836), but inferior to the overall survival (OS) of surgical treatment alone (p<0.001) in T1-2N0M0 patients. Patients receiving nRT had distinctly better survival than those receiving surgical treatment alone (p = 0.008), but had similar survival compared with patients treated with aRT (p = 0.989) or surgery combined with chemotherapy (p = 0.205) in the T3N0/T1-3N+M0 subgroup. The efficacy of nRT is clearly stronger than that of surgical therapy alone (p<0.001), surgery combined with chemotherapy (p<0.001), and aRT (p = 0.008) in patients with T4 stage. The survival analysis results were consistent before and after propensity score matching.
In these carefully selected patients, the present study made the following recommendations: nRT can improve the prognosis of patients with T3N0M0/T1-3N+M0 and T4 Siewert type II GEA, and it seems to be a better treatment for T4 patients. Surgery alone seems to be sufficient, and nRT is not conducive to prolonging the survival of Siewert II GEA patients with T1-2N0M0 stage. Of course, further prospective trials are needed to verify this conclusion.
分析新辅助放疗（nRT）对局部区域型 Siewert Ⅱ型胃食管结合部腺癌（GEA）患者预后的影响。
从 Surveillance, Epidemiology and Final Results（SEER）数据库中检索 2004 年至 2015 年间所有病理诊断为 Siewert Ⅱ型 GEA 的患者。我们分析了不同治疗方案在各期的预后影响。采用 Kaplan-Meier（K-M）法进行生存分析。进一步采用多变量 Cox 模型和倾向评分匹配法验证结果。
本研究共纳入 4160 例患者。nRT 的疗效优于辅助放疗（aRT）（p = 0.048），与手术联合化疗（p = 0.836）相当，但不如单纯手术治疗的总生存期（OS）（p<0.001）好，在 T1-2N0M0 患者中。接受 nRT 的患者的生存情况明显优于单独接受手术治疗的患者（p = 0.008），但与接受 aRT（p = 0.989）或手术联合化疗（p = 0.205）的患者的生存情况相似在 T3N0/T1-3N+M0 亚组中。在 T4 期患者中，nRT 的疗效明显强于单独手术治疗（p<0.001）、手术联合化疗（p<0.001）和 aRT（p = 0.008）。倾向性评分匹配前后的生存分析结果一致。
在这些精心挑选的患者中，本研究提出以下建议：nRT 可改善 T3N0M0/T1-3N+M0 和 T4 型 Siewert Ⅱ型 GEA 患者的预后，似乎是 T4 期患者的更好治疗方法。单纯手术似乎足够了，nRT 不利于延长 T1-2N0M0 期 Siewert II GEA 患者的生存。当然，还需要进一步的前瞻性试验来验证这一结论。
