Gao Huijiang, Wang Yuanyong, Jiang Zhihui, Shi Guodong, Hu Shiyu, Ai Jiangshan, Wang Zhaofeng, Wei Yucheng
Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.
Department of Thoracic Surgery, Tangdu Hospital of Air Force Military Medical University, Xi’an, China.
Aging (Albany NY). 2023 Apr 25;15(8):3158-3170. doi: 10.18632/aging.204677.
This study was conducted to elucidate the link between adjuvant radiotherapy and survival in pathologic node-negative (pN0) esophageal cancer patients with upfront esophagectomy.
From 2000 to 2016, patients with pN0 esophageal cancer who underwent upfront esophagectomy were selected from the Surveillance, Epidemiology, and End Results (SEER) database. The association of high-risk covariates with survival after adjuvant radiotherapy was evaluated using propensity score matching and multivariate analysis.
We identified 3197 patients, 321 (10.0%) underwent postoperative radiotherapy and 2876 (90.0%) underwent esophagectomy alone. In the unmatched cohort, postoperative radiotherapy was associated with a statistically significant but modest absolute decrease in survival outcomes (P < 0.001). In the matched cohort, the survival differences disappeared. Additionally, adjuvant radiotherapy was linked to a 5-year overall survival (OS) benefit for patients with the pT3-4N0 disease (34.8% vs. 27.7%; P = 0.008). Adjuvant radiotherapy for pT3-4N0 disease with tumor length ≥3 cm, adenocarcinoma, and evaluated lymph node count <12 was shown to independently function as a risk factor for improved OS, as per a multivariate analysis (P < 0.01).
This population-based trial showed that high-risk patients with pT3-4N0 esophageal cancer had better OS following upfront esophagectomy followed by radiotherapy therapy. This discovery may have major significance in the use of adjuvant radiotherapy following upfront esophagectomy in patients with pN0 esophageal cancer.
本研究旨在阐明术前接受食管切除术的病理淋巴结阴性（pN0）食管癌患者辅助放疗与生存之间的联系。
从2000年至2016年，从监测、流行病学和最终结果（SEER）数据库中选取接受术前食管切除术的pN0食管癌患者。使用倾向评分匹配和多变量分析评估高危协变量与辅助放疗后生存的相关性。
我们确定了3197例患者，其中321例（10.0%）接受了术后放疗，2876例（90.0%）仅接受了食管切除术。在未匹配队列中，术后放疗与生存结果的统计学显著但适度的绝对降低相关（P < 0.001）。在匹配队列中，生存差异消失。此外，辅助放疗与pT3-4N0疾病患者的5年总生存（OS）获益相关（34.8%对27.7%；P = 0.008）。多变量分析显示，对于肿瘤长度≥3 cm、腺癌且评估淋巴结计数<12的pT3-4N0疾病，辅助放疗可独立作为改善OS的危险因素（P < 0.01）。
这项基于人群的试验表明，pT3-4N0食管癌高危患者在术前食管切除术后接受放疗，其OS更佳。这一发现可能对pN0食管癌患者术前食管切除术后辅助放疗的应用具有重要意义。
