Han Weiming, Chang Xiao, Zhang Wencheng, Yang Jingsong, Yu Shufei, Deng Wei, Ni Wenjie, Zhou Zongmei, Chen Dongfu, Feng Qinfu, Liang Jun, Hui Zhouguang, Wang Lvhua, Gao Shugeng, Lin Yu, Chen Xiaohui, Chen Junqiang, Xiao Zefen
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 100021, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
Cancers (Basel). 2022 Nov 29;14(23):5879. doi: 10.3390/cancers14235879.
Background: For patients with esophageal squamous cell carcinoma (ESCC) treated with surgery alone, the incidence of local-regional recurrence remains unfavorable. Postoperative radiotherapy (PORT) has been associated with increased local-regional recurrence-free survival (LRFS), although its application is limited by concerns of PORT-related toxicities. Methods: Among 3591 patients with ESCC analyzed in this study, 2765 patients with T3-4N0 and T1-4N1-3 lesions and specific local-regional status information were analyzed in a subsequent analysis of adjuvant radiation dose (aRTD) effect. Application of the restricted cubic spline regression model revealed a non-linear relationship between aRTD and survival/radiotoxicity. Linear regression analysis (LRA) was performed to evaluate correlations between LRFS and overall survival (OS)/ disease-free survival (DFS). Results: For patients staged T1−2N0, T1−2N1−3, T3−4N0, and T3−4N1−3, 5-year OS in PORT and non-PORT groups were 77.38% vs. 72.91%, p = 0.919, 52.35% vs. 46.60%, p = 0.032, 73.41% vs. 61.19%, p = 0.005 and 38.30% vs. 25.97%, p < 0.001. With aRTD escalation, hazard ratios (HRs) of OS/DFS declined until aRTD exceeded 50Gy, then increased, whereas that of LRFS declined until aRTD exceeded 50 Gy, then remained steady. HR of treatment-related mortality was stable until aRTD exceeded 50 Gy, then increased. LRA revealed strong correlations between LRFS and OS/DFS (r = 0.984 and r = 0.952, respectively). An absolute 1% advancement in LRFS resulted in 0.32% and 0.34% improvements in OS and DFS. Conclusions: An aRTD of 50Gy was well-tolerated, with favorable survival resulting from PORT-related LRFS improvement in patients staged T3−4N0 or T1-4N1−3. Further stratification analyses based on tumor burden would help determine potential PORT-beneficiaries.
对于仅接受手术治疗的食管鳞状细胞癌（ESCC）患者，局部区域复发率仍然较高。术后放疗（PORT）与局部区域无复发生存期（LRFS）的提高相关，尽管其应用受到PORT相关毒性担忧的限制。方法：在本研究分析的3591例ESCC患者中，对2765例T3-4N0和T1-4N1-3病变且具有特定局部区域状态信息的患者进行了辅助放疗剂量（aRTD）效应的后续分析。应用受限立方样条回归模型揭示了aRTD与生存/放射毒性之间的非线性关系。进行线性回归分析（LRA）以评估LRFS与总生存期（OS）/无病生存期（DFS）之间的相关性。结果：对于T1−2N0、T1−2N1−3、T3−4N0和T3−4N1−3分期的患者，PORT组和非PORT组的5年OS分别为77.38%对72.91%，p = 0.919；52.35%对46.60%，p = 0.032；73.41%对61.19%，p = 0.005；38.30%对25.97%，p < 0.001。随着aRTD的增加，OS/DFS的风险比（HRs）下降，直到aRTD超过50Gy，然后增加，而LRFS的HRs下降，直到aRTD超过50Gy，然后保持稳定。治疗相关死亡率的HR直到aRTD超过50Gy时保持稳定，然后增加。LRA显示LRFS与OS/DFS之间存在强相关性（r分别为0.984和0.952）。LRFS绝对提高1%导致OS和DFS分别提高0.32%和0.34%。结论：50Gy的aRTD耐受性良好，T3−4N0或T1-4N1−3分期的患者因PORT相关的LRFS改善而具有良好的生存率。基于肿瘤负荷的进一步分层分析将有助于确定潜在的PORT受益者。
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