Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Department of Radiation Oncology, The First Affiliated Hospital of Qiqihar Medical College, Qiqihar, Heilongjiang Province, China.
Int J Clin Oncol. 2022 Feb;27(2):340-347. doi: 10.1007/s10147-021-02056-x. Epub 2021 Nov 3.
Currently, the optimal treatment strategy for locally advanced esophageal cancer (LAEC) remains controversial. We perform the present study to compare the outcomes of LAEC treated with neoadjuvant chemotherapy (neo-CT) or chemoradiotherapy (neo-CRT).
A population cohort with histologically diagnosed of esophageal cancer was identified from SEER database between 2004 and 2015. The Kaplan-Meier method and Cox-regression proportional hazards model were used to assess the impact of neoadjuvant treatment regimens on the cause-specific survival (CSS) and overall survival (OS) of LAEC. A propensity score model was utilized to balance baseline covariates.
After propensity score matching, a total of 1986 LAEC patients were included for analysis, 1,655 patients treated with neo-CRT and 331 with neo-CT, respectively. The survival outcomes of LAEC treated with neo-CRT were comparable to those treated with neo-CT in terms of 5-year OS (39% vs. 36%, p = 0.63) and CSS (51% vs. 51%, p = 0.77). In the multivariate Cox analyses, sex, histological grade, ypT stage, ypN( +), and number of LN examined were independent factors for predicting OS and CSS among LAEC treated with neoadjuvant treatment.
The present study based on large cohort demonstrated that no significant survival difference was observed between LAEC patients treated with neo-CRT versus neo-CT. However, the results needed to be confirmed in well-designed prospective trials.
目前，局部晚期食管癌（LAEC）的最佳治疗策略仍存在争议。我们进行本研究旨在比较新辅助化疗（neo-CT）或放化疗（neo-CRT）治疗 LAEC 的结果。
从 SEER 数据库中确定了 2004 年至 2015 年间经组织学诊断为食管癌的人群队列。采用 Kaplan-Meier 方法和 Cox 回归比例风险模型评估新辅助治疗方案对 LAEC 的特异性生存（CSS）和总生存（OS）的影响。采用倾向评分模型平衡基线协变量。
经过倾向评分匹配后，共纳入 1986 例 LAEC 患者进行分析，分别有 1655 例患者接受 neo-CRT 治疗，331 例患者接受 neo-CT 治疗。接受 neo-CRT 治疗的 LAEC 的生存结果与接受 neo-CT 治疗的患者在 5 年 OS（39%比 36%，p=0.63）和 CSS（51%比 51%，p=0.77）方面相当。多变量 Cox 分析显示，性别、组织学分级、ypT 分期、ypN(+)和检查的淋巴结数量是 LAEC 接受新辅助治疗后预测 OS 和 CSS 的独立因素。
本研究基于大样本队列表明，接受 neo-CRT 与 neo-CT 治疗的 LAEC 患者之间未观察到生存差异有统计学意义。然而，这些结果需要在精心设计的前瞻性试验中得到证实。
