Department of Thoracic Surgery, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, Fujian, China.
Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420, Fuma Road, Fuzhou, 350014, China.
BMC Cancer. 2021 Oct 21;21(1):1130. doi: 10.1186/s12885-021-08838-w.
To aid clinicians strategizing treatment for upper esophageal squamous cell carcinoma (ESCC), this retrospective study investigated associations between primary gross tumor volume (GTVp) and prognosis in patients given surgical resection, radiotherapy, or both resection and radiotherapy.
The population comprised 568 patients with upper ESCC given definitive treatment, including 238, 216, and 114 who underwent surgery, radiotherapy, or combined radiotherapy and surgery. GTVp as a continuous variable was entered into the multivariate Cox model using penalized splines (P-splines) to determine the optimal cutoff value. Propensity score matching (PSM) was used to adjust imbalanced characteristics among the treatment groups.
P-spline regression revealed a dependence of patient outcomes on GTVp, with 30 cm being an optimal cut-off for differences in overall and progression-free survival (OS, PFS). GTVp ≥30 cm was a negative independent prognostic factor for OS and PFS. PSM analyses confirmed the prognostic value of GTVp. For GTVp < 30 cm, no significant survival differences were observed among the 3 treatments. For GTVp ≥30 cm, the worst 5-year OS rate was experienced by those given surgery. The 5-year PFS rate of patients given combined radiotherapy and surgery was significantly better than that of patients given radiotherapy. The surgical complications of patients given the combined treatment were comparable to those who received surgery, but radiation side effects were significantly lower.
GTVp is prognostic for OS and PFS in upper ESCC. For patients with GTVp ≥30 cm, radiotherapy plus surgery was more effective than either treatment alone.
为帮助临床医生制定治疗上食管鳞癌（ESCC）的策略，本回顾性研究调查了接受手术切除、放疗或手术联合放疗的患者原发肿瘤大体体积（GTVp）与预后之间的关系。
该人群包括 568 例接受确定性治疗的上 ESCC 患者，其中 238 例、216 例和 114 例分别接受手术、放疗或联合放疗和手术。使用惩罚样条（P-splines）将 GTVp 作为连续变量输入多变量 Cox 模型，以确定最佳截断值。采用倾向评分匹配（PSM）调整治疗组之间的不平衡特征。
P-spline 回归显示患者结局与 GTVp 相关，GTVp 为 30cm 时，总生存（OS）和无进展生存（PFS）的差异具有最佳截断值。GTVp≥30cm 是 OS 和 PFS 的独立负预后因素。PSM 分析证实了 GTVp 的预后价值。对于 GTVp<30cm，3 种治疗方法之间的生存差异无统计学意义。对于 GTVp≥30cm，手术组患者的 5 年 OS 率最差。接受放化疗联合治疗的患者 5 年 PFS 率明显优于放疗组。联合治疗组患者的手术并发症与手术组相当，但放射副作用明显较低。
GTVp 对上食管 ESCC 的 OS 和 PFS 具有预后价值。对于 GTVp≥30cm 的患者，放疗联合手术比单独治疗更有效。
