Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Ann Thorac Surg. 2022 Dec;114(6):2032-2040. doi: 10.1016/j.athoracsur.2021.10.046. Epub 2021 Dec 6.
In retrospective studies the definition of salvage esophagectomy has been inconsistent and is a source of bias. We sought to describe how variability in the definition of salvage affects comparative outcomes of trimodality therapy (TMT) and bimodality therapy (BMT).
Patients with locally advanced esophageal squamous cell carcinoma who completed chemoradiation therapy (CRT) from 2002 to 2017 were identified. TMT included patients who had a planned esophagectomy after CRT. BMT included patients treated with CRT only plus salvage esophagectomy, variably defined as an esophagectomy occurring (A) 3 months after CRT; (B) 3 months after CRT, excluding delayed recovery; (C) 3 months after CRT, excluding delayed workup; or (D) 6 months after CRT. Long-term survival outcomes between the TMT and BMT groups were compared for each definition of salvage esophagectomy. Time to surgery was included a priori in a multivariable model for overall survival.
Of 143 patients, 90 (63%) underwent esophagectomy and 53 (37%) received CRT only. Although the total patients remained the same, the composition of the TMT and BMT groups varied by salvage definitions A through D. Various definitions resulted in different 5-year survival rates for TMT vs BMT groups: (A) 56% vs 39%, (B) 61% vs 34%, (C) 50% vs 42%, and (D) 51% vs 39%. In a Cox multivariable analysis age and proximal/middle esophageal tumors were associated with worse postoperative survival, but time to surgery was not.
Slight variations in the definition of salvage esophagectomy can influence the interpretation of TMT and BMT outcomes. Future studies should consistently define treatment groups.
在回顾性研究中，挽救性食管切除术的定义一直不一致，这也是产生偏差的一个原因。我们旨在描述挽救性食管切除术定义的变化如何影响新辅助放化疗（NACT）联合手术治疗（TMT）和单纯 NACT 治疗（BMT）的比较结果。
从 2002 年至 2017 年，我们确定了完成放化疗（CRT）的局部晚期食管鳞状细胞癌患者。TMT 包括在 CRT 后计划行食管切除术的患者。BMT 包括仅接受 CRT 加挽救性食管切除术的患者，挽救性食管切除术的定义各不相同，包括（A）在 CRT 后 3 个月进行；（B）在 CRT 后 3 个月，排除延迟恢复；（C）在 CRT 后 3 个月，排除延迟检查；或（D）在 CRT 后 6 个月进行。对于每种挽救性食管切除术的定义，比较 TMT 和 BMT 组之间的长期生存结果。手术时间预先纳入总体生存的多变量模型。
在 143 名患者中，90 名（63%）接受了食管切除术，53 名（37%）仅接受了 CRT。尽管总患者人数保持不变，但 TMT 和 BMT 组的组成因挽救性食管切除术的 A 至 D 定义而异。不同的定义导致 TMT 与 BMT 组的 5 年生存率不同：（A）56%对 39%，（B）61%对 34%，（C）50%对 42%，和（D）51%对 39%。在 Cox 多变量分析中，年龄和中段/上段食管肿瘤与术后生存较差相关，但手术时间与术后生存无关。
挽救性食管切除术定义的细微变化可能影响 TMT 和 BMT 结果的解释。未来的研究应一致定义治疗组。
Zotero 插件