Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
Department of Radiation Oncology, National Institutes for Quantum and Radiological Science and Technology, QST Hospital, Chiba, Japan.
Esophagus. 2024 Oct;21(4):484-494. doi: 10.1007/s10388-024-01068-6. Epub 2024 Jun 6.
Proton-based, definitive chemoradiotherapy (P-CRT) for esophageal squamous cell carcinoma (ESCC) previously showed comparable survival outcomes with the surgery-based therapy, i.e., neoadjuvant chemotherapy followed by esophagectomy (NAC-S), in a single-institutional study. This study aimed to validate this message in a Japanese multicenter study.
Eleven Japanese esophageal cancer specialty hospitals have participated. A total of 518 cases with clinical Stage I-IVA ESCC between 2010 and 2019, including 168 P-CRT and 350 NAC-S patients, were enrolled and long-term outcomes were evaluated. Propensity-score weighting analyses with overlap weighting for confounding adjustment were used.
The 3-year overall survival (OS) of the P-CRT group was equivalent to the NAC-S group (74.8% vs. 72.7%, hazard ratio [HR]: 0.87, 95% confidence interval [CI]: 0.61-1.25). Although, the 3-year P-CRT group progression-free survival (PFS) was inferior to the NAC-S group (51.4% vs. 59.6%, HR 1.39, 95% CI 1.04-1.85), the progression P-CRT group cases showed better survival than the NAC-S group (HR 0.58, 95% CI 0.38-0.88), largely because of salvage surgery or endoscopic submucosal dissection for local progression. The survival advantage of P-CRT over NAC-S was more pronounced in the cT1-2 (HR 0.61, 95% CI 0.29-1.26) and cStage I-II (HR 0.50, 95% CI 0.24-1.07) subgroups, although this trend was not evident in other populations, such as cT3-4 and cStage III-IVA.
Proton-based CRT for ESCC showed equivalent OS to surgery-based therapy. Especially for patients with cT1-2 and cStage I-II disease, proton-based CRT has the potential to serve as a first-line treatment.
质子放疗联合根治性放化疗（P-CRT）治疗食管鳞癌（ESCC）的生存结果与基于手术的治疗方法（新辅助化疗后手术治疗，NAC-S）相当，这一结果来自于单中心研究。本研究旨在日本多中心研究中验证这一结论。
共有 11 家日本食管癌专业医院参与了本研究。2010 年至 2019 年间，共纳入 518 例临床分期为 I-IVA 期的 ESCC 患者，包括 168 例接受 P-CRT 和 350 例接受 NAC-S 的患者，评估了这些患者的长期生存结局。采用倾向评分加权分析，并使用重叠加权法进行混杂因素调整。
P-CRT 组的 3 年总生存（OS）与 NAC-S 组相当（74.8% vs. 72.7%，风险比 [HR]：0.87，95%置信区间 [CI]：0.61-1.25）。尽管 P-CRT 组的 3 年无进展生存（PFS）劣于 NAC-S 组（51.4% vs. 59.6%，HR 1.39，95% CI 1.04-1.85），但 P-CRT 组局部进展患者的生存情况优于 NAC-S 组（HR 0.58，95% CI 0.38-0.88），这主要归因于局部进展后的挽救性手术或内镜黏膜下剥离术。P-CRT 在 cT1-2（HR 0.61，95% CI 0.29-1.26）和 c 期 I-II（HR 0.50，95% CI 0.24-1.07）亚组中的生存优势更为显著，尽管在其他人群中，如 cT3-4 和 c 期 III-IVA 中，这种趋势并不明显。
质子放疗联合根治性放化疗治疗 ESCC 的生存结果与手术治疗相当。特别是对于 cT1-2 和 c 期 I-II 期的患者，质子放疗有可能成为一线治疗选择。
