倾向评分分析比较食管鳞癌患者根治性放化疗与根治性手术加辅助放化疗的生存差异。

Propensity score analysis comparing survival between definitive chemoradiotherapy and esophagectomy with adjuvant chemoradiotherapy in patients with esophageal squamous cell carcinoma.

机构信息

Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.

Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.

出版信息

PLoS One. 2022 Oct 13;17(10):e0271338. doi: 10.1371/journal.pone.0271338. eCollection 2022.

DOI:10.1371/journal.pone.0271338

PMID:36227954

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9560125/

Abstract

INTRODUCTION

The purpose of the current study is to compare definitive chemoradiotherapy and esophagectomy with adjuvant chemoradiotherapy in patients with cT1-3/N0-3 esophageal squamous cell carcinoma in survival.

METHODS

Records from 2008 to 2014 of 4931 patients with clinical T1-3/N0-3 esophageal squamous cell carcinoma receiving definitive chemoradiotherapy or esophagectomy with adjuvant chemoradiotherapy were obtained from the Taiwan Cancer Registry. Univariable and multivariable analyses were performed and propensity score matching was used to minimize the bias. Overall survival was compared between definitive chemoradiotherapy and esophagectomy with adjuvant chemoradiotherapy, and also in the three different clinical stages.

RESULTS

Definitive chemoradiotherapy was performed on 4381 patients, and 550 patients received esophagectomy adjuvant chemoradiotherapy. Each group produced 456 patients for comparison after propensity score matching. The 1-year, 2-year, and 3-year overall survival rates for matched patients in with definitive chemoradiotherapy group were 57.18%, 31.92%, and 23.8%. The 1-year, 2-year, and 3-year overall survival rates for matched patients treated in the esophagectomy with adjuvant chemoradiotherapy group were 72.35%, 45.74%, and 34.04%(p<0.0001). In multivariable analysis, treatment modality was an independent prognostic factor. Esophagectomy with adjuvant chemoradiotherapy provided better survival outcome than definitive chemoradiotherapy for patients with clinical stage II/III disease. As for patients with clinical stage I disease, there was no significant survival difference between definitive chemoradiotherapy and esophagectomy with adjuvant chemoradiotherapy.

CONCLUSIONS

Esophagectomy with adjuvant chemoradiotherapy provided better survival than definitive chemoradiotherapy in clinical II/III esophageal squamous cell carcinoma. However, more data are needed to conduct a convincing conclusion in clinical stage I patients.

摘要

简介

本研究旨在比较 cT1-3/N0-3 期食管鳞癌患者接受根治性放化疗与术后辅助放化疗的生存情况。

方法

从台湾癌症登记处获取了 2008 年至 2014 年间 4931 例接受根治性放化疗或术后辅助放化疗的临床 T1-3/N0-3 期食管鳞癌患者的记录。进行了单变量和多变量分析，并采用倾向评分匹配来最小化偏倚。比较了根治性放化疗与术后辅助放化疗以及在三个不同临床分期之间的总生存率。

结果

4381 例患者接受了根治性放化疗，550 例患者接受了术后辅助放化疗。经倾向评分匹配后，每组各有 456 例患者进行比较。在根治性放化疗组中，匹配患者的 1 年、2 年和 3 年总生存率分别为 57.18%、31.92%和 23.8%。在术后辅助放化疗组中，匹配患者的 1 年、2 年和 3 年总生存率分别为 72.35%、45.74%和 34.04%（p<0.0001）。多变量分析显示，治疗方式是独立的预后因素。对于临床 II/III 期疾病患者，术后辅助放化疗比根治性放化疗提供更好的生存结局。对于临床 I 期疾病患者，根治性放化疗与术后辅助放化疗之间的生存差异无统计学意义。