Jensen Garrett L, Hammonds Kendall P, Haque Waqar
Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Biostatistics, Baylor Scott & White Health, Temple, TX, USA.
Dis Esophagus. 2023 Jan 28;36(2). doi: 10.1093/dote/doac050.
The addition of surgery to chemoradiation for esophageal cancer has not shown a survival benefit in randomized trials. Patients with more comorbidities or advanced age are more likely to be given definitive chemoradiation due to surgical risk. We aimed to identify subsets of patients in whom the addition of surgery to chemoradiation does not provide an overall survival (OS) benefit. The National Cancer Database was queried for patients with locally advanced esophageal cancer who received either definitive chemoradiation or neoadjuvant chemoradiation followed by surgery. Bivariate analysis was used to assess the association between patient characteristics and treatment groups. Log-rank tests and Cox proportional hazards models were performed to assess for differences in survival. A total of 15,090 with adenocarcinoma and 5,356 with squamous cell carcinoma met the inclusion criteria. Patients treated with neoadjuvant chemoradiation and surgery had significantly improved survival by Cox proportional hazards model regardless of histology if <50, 50-60, 61-70, or 71-80 years old. There was no significant benefit or detriment in patients 81-90 years old. Survival advantage was also significant with a Charlson/Deyo comorbidity condition score of 0, 1, 2, and ≥3 in adenocarcinoma squamous cell carcinoma with scores of 2 or ≥3 had no significant benefit or detriment. Patients 81-90 years old or with squamous cell carcinoma and a Charlson/Deyo comorbidity score ≥ 2 lacked an OS benefit from neoadjuvant chemoradiation followed by surgery compared with definitive chemoradiation. Careful consideration of esophagectomy-specific surgical risks should be used when recommending treatment for these patients.
在随机试验中，食管癌放化疗联合手术并未显示出生存获益。由于手术风险，合并症较多或年龄较大的患者更有可能接受根治性放化疗。我们旨在确定放化疗联合手术不能带来总生存期（OS）获益的患者亚组。我们在国家癌症数据库中查询了局部晚期食管癌患者，这些患者接受了根治性放化疗或新辅助放化疗后再行手术。采用双变量分析评估患者特征与治疗组之间的关联。进行对数秩检验和Cox比例风险模型以评估生存率差异。共有15090例腺癌患者和5356例鳞状细胞癌患者符合纳入标准。根据Cox比例风险模型，接受新辅助放化疗和手术治疗的患者，无论组织学类型如何，年龄<50岁、50 - 60岁、61 - 70岁或71 - 80岁时，生存期均有显著改善。81 - 90岁的患者未显示出显著获益或损害。在腺癌患者中，Charlson/Deyo合并症状况评分为0、1、2和≥3时，生存优势也显著；鳞状细胞癌患者评分为2或≥3时，未显示出显著获益或损害。与根治性放化疗相比，81 - 90岁或患有鳞状细胞癌且Charlson/Deyo合并症评分≥2的患者，新辅助放化疗后再行手术未带来OS获益。在为这些患者推荐治疗方案时，应仔细考虑食管切除术特有的手术风险。
