Department of VIP Medical Services & 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.
Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi'an, China.
Am J Gastroenterol. 2023 Aug 1;118(8):1344-1352. doi: 10.14309/ajg.0000000000002257. Epub 2023 Mar 23.
Adjuvant radiotherapy is recommended for pT1b esophageal squamous cell cancer (ESCC) after endoscopic submucosal dissection (ESD). However, it is unclear whether additional radiotherapy can improve patient survival. This study aimed to evaluate the efficacy of adjuvant radiotherapy after ESD for pT1b ESCC.
This was a multicenter, cross-sectional study involving 11 hospitals in China. Between January 2010 and December 2019, patients with T1bN0M0 ESCC treated with or without adjuvant radiotherapy after ESD were included. Survival between groups was compared.
Overall, 774 patients were screened, and 161 patients were included. Forty-seven patients (29.2%) received adjuvant radiotherapy after ESD (RT group) and 114 (70.8%) underwent ESD alone (non-RT group). There were no significant differences in overall survival (OS) and disease-free survival (DFS) between the RT and non-RT groups. Lymphovascular invasion (LVI) was the only prognostic factor. In the LVI+ group, adjuvant radiotherapy significantly improved survival (5-year OS: 91.7% vs 59.5%, P = 0.050; 5-year DFS: 92.9% vs 42.6%, P = 0.010). In the LVI- group, adjuvant radiotherapy did not improve survival (5-year OS: 83.5% vs 93.9%, P = 0.148; 5-year DFS: 84.2% vs 84.7%, P = 0.907). The standardized mortality ratios were 1.52 (95% confidence interval 0.04-8.45) in the LVI+ group with radiotherapy and 0.55 (95% confidence interval 0.15-1.42) in the LVI- group without radiotherapy.
Adjuvant radiotherapy could improve survival in pT1b ESCC with LVI+ other than LVI- after ESD. Selective adjuvant radiotherapy based on LVI status achieved survival rates similar to those of the general population.
内镜黏膜下剥离术（ESD）后推荐对 pT1b 食管鳞癌（ESCC）进行辅助放疗。然而，辅助放疗是否能改善患者的生存情况仍不清楚。本研究旨在评估 ESD 后辅助放疗对 pT1b ESCC 的疗效。
这是一项在中国 11 家医院进行的多中心、横断面研究。纳入了 2010 年 1 月至 2019 年 12 月接受或未接受 ESD 后辅助放疗的 T1bN0M0 ESCC 患者。比较两组患者的生存情况。
共筛选出 774 例患者，其中纳入 161 例患者。47 例（29.2%）患者在 ESD 后接受了辅助放疗（RT 组），114 例（70.8%）患者仅接受了 ESD（非 RT 组）。RT 组和非 RT 组的总生存（OS）和无病生存（DFS）无显著差异。血管淋巴管侵犯（LVI）是唯一的预后因素。在 LVI+组中，辅助放疗显著改善了生存情况（5 年 OS：91.7%比 59.5%，P=0.050；5 年 DFS：92.9%比 42.6%，P=0.010）。在 LVI-组中，辅助放疗未改善生存情况（5 年 OS：83.5%比 93.9%，P=0.148；5 年 DFS：84.2%比 84.7%，P=0.907）。在 LVI+组中，放疗组的标准化死亡比为 1.52（95%置信区间 0.04-8.45），在 LVI-组中，未放疗组为 0.55（95%置信区间 0.15-1.42）。
ESD 后对于 LVI+的 pT1b ESCC 患者，辅助放疗可改善生存情况，而对于 LVI-的患者则不然。基于 LVI 状态的选择性辅助放疗可达到与一般人群相似的生存率。
