年龄在食管鳞状细胞癌（ESCC）确定性同步放化疗（CCRT）决策中起着重要作用：一项多中心数据的倾向评分匹配分析（3JECROG R-02A）

Age plays an important role in the decision of definitive concurrent chemoradiotherapy (CCRT) for esophageal squamous cell carcinoma (ESCC): a propensity-score matched analysis of multicenter data (3JECROG R-02A).

作者信息

Wang Lan, Wang Xin, Ren Xuejiao, Han Chun, Xiao Zefen, Zhu Shuchai, Qiao Xueying, Zhou Zhiguo, Shen Wenbin, Chen Junqiang, Pang Qingsong, Zhang Wencheng, Zhao Yidian, Wang Xiaomin, Sun Xinchen, Ge Xiaolin, Zhang Kaixian, Hu Miaomiao, Li Gaofeng, Liu Miaoling, Wang Yadi

机构信息

Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.

Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

Transl Cancer Res. 2021 Jun;10(6):2932-2943. doi: 10.21037/tcr-21-505.

DOI:10.21037/tcr-21-505

PMID:35116602

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8797428/

Abstract

BACKGROUND

To examine the survival benefit of definitive concurrent chemoradiotherapy (CCRT) compared to radiotherapy alone in patients with esophageal squamous cell carcinoma (ESCC) using a real-world patient population.

METHODS

This retrospective study included 2,762 patients with ESCC across ten medical centers in China from 2001 to 2017. A total of 1,133 patients received radiotherapy alone and 815 patients were treated with CCRT. The patient survival rates were assessed by propensity-score matching (PSM) and subgroup analysis.

RESULTS

The baseline characteristics were significantly different between the two groups, with the CCRT group showing a higher proportion of males, younger patients, cervical/upper thoracic cancers, and worse T and N stages. There were no significant differences in the clinical characteristics between the two groups after PSM. Before PSM, the median overall survival (OS) rates were 31.2 and 24.1 months in the CCRT and RT alone groups, respectively, demonstrating the superior therapeutic effects (TEs) of the CCRT. However, the median OS rates were not significantly different between the two groups after PSM (32.6 and 39.4 months in the CCRT and radiotherapy alone groups, respectively). The subgroup analyses revealed that the median OS was significantly better in the CCRT group compared to the radiotherapy alone group (37.5 25.1 months, respectively) in patients less than 70 years of age [hazard ratio (HR) 0.782, 95% confidence interval (CI): 0.657 to 0.932]. In contrast, in patients 70 years of age and older, the 5-year survival rate was poorer in the CCRT group (34.8%) compared to the radiotherapy alone group (73.4%). Therefore, CCRT was an independent poor prognostic risk factor (HR 3.206, 95% CI: 2.168 to 4.740).

CONCLUSIONS

CCRT may not be suitable for all patients with localized ESCC. Younger patients less than 70 years of age might benefit significantly from CCRT. However, in patients aged 70 years and older, the potential survival benefit of CCRT and the optimal combination treatment regimens require further investigation.

摘要

背景

利用真实世界的患者群体，比较根治性同步放化疗（CCRT）与单纯放疗对食管鳞状细胞癌（ESCC）患者的生存获益。

方法

这项回顾性研究纳入了2001年至2017年期间来自中国十个医疗中心的2762例ESCC患者。共有1133例患者接受单纯放疗，815例患者接受CCRT。通过倾向评分匹配（PSM）和亚组分析评估患者生存率。

结果

两组患者的基线特征存在显著差异，CCRT组男性、年轻患者、颈段/上胸段癌以及T和N分期较差的比例更高。PSM后两组患者的临床特征无显著差异。PSM前，CCRT组和单纯放疗组的中位总生存期（OS）分别为31.2个月和24.1个月，表明CCRT具有更好的治疗效果（TEs）。然而，PSM后两组的中位OS无显著差异（CCRT组和单纯放疗组分别为32.6个月和39.4个月）。亚组分析显示，年龄小于70岁的患者中，CCRT组的中位OS显著优于单纯放疗组（分别为37.5个月和25.1个月）[风险比（HR）0.782，95%置信区间（CI）：0.657至0.932]。相反，70岁及以上患者中，CCRT组的5年生存率（34.8%）低于单纯放疗组（73.4%）。因此，CCRT是一个独立的不良预后危险因素（HR 3.206，95% CI：2.168至4.740）。