新辅助放化疗中降低化疗相对剂量强度会降低局部晚期食管癌患者的总生存期。

Reduction in chemotherapy relative dose intensity decreases overall survival of neoadjuvant chemoradiotherapy in patients with locally advanced esophageal carcinoma.

机构信息

Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.

Department of Oncology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China.

出版信息

BMC Cancer. 2024 Aug 2;24(1):945. doi: 10.1186/s12885-024-12724-6.

DOI:10.1186/s12885-024-12724-6

PMID:39095767

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11297780/

Abstract

BACKGROUND

Many patients undergo dose reduction or early termination of chemotherapy to reduce chemoradiotherapy-related toxicity, which may increase their risk of survival. However, this strategy may result in underdosing patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC). This study aimed to analyze the relationship between the relative dose intensity (RDI) and survival outcomes in patients with LA-ESCC.

METHODS

This retrospective study assessed patients with LA-ESCC (cT2N + M0, cT3-4NanyM0) receiving neoadjuvant chemoradiotherapy (NCRT) with curative-intent esophagectomy. The patients received 2 courses of paclitaxel plus carboplatin (TC) combination radiotherapy prior to undergoing surgery. During NCRT, RDI was computed, defined as the received dose as a percentage of the standard dose, and the incidence of dose delays was estimated (≥ 7 days in any course cycle). The best RDI cutoff value (0.7) was obtained using ROC curve. The Kaplan-Meier survival curves were compared using the log-rank test, the treatment effect was measured using hazard ratios (HR) and 95% confidence intervals (CI).

RESULTS

We included 132 patients in this study, divided into RDI < 0.7 and RDI ≥ 0.7 groups using cut-off value of 0.7. RDI grade was an independent prognostic factor for OS. Baseline demographic and clinical characteristics were well balanced between the groups. There was no evidence that patients with RDI < 0.7 experienced less toxicity or those with RDI ≥ 0.7 resulted in more toxicity. However, patients with RDI < 0.7 who were given reduced doses had a worse overall survival [HR 0.49, 95% CI 0.27-0.88, P = 0.015]. The risk of a lower RDI increased with a longer dose delay time (P < 0.001).

CONCLUSION

The RDI below 0.7 for avoiding chemoradiotherapy toxicity administration led to a reduction in the dose intensity of treatment and decreased overall survival.

摘要

背景

许多患者为降低化疗的放化疗相关毒性而减少剂量或提前终止化疗，这可能会增加其生存风险。然而，这一策略可能导致局部晚期食管鳞状细胞癌（LA-ESCC）患者剂量不足。本研究旨在分析 LA-ESCC 患者相对剂量强度（RDI）与生存结局的关系。

方法

本回顾性研究纳入了接受新辅助放化疗（NCRT）联合根治性食管切除术的 LA-ESCC（cT2N+M0，cT3-4NanyM0）患者。患者在手术前接受了 2 个疗程的紫杉醇联合卡铂（TC）联合放疗。在 NCRT 期间，计算了 RDI，定义为接受的剂量与标准剂量的百分比，并估计了剂量延迟的发生率（任何疗程周期中≥7 天）。使用 ROC 曲线获得最佳 RDI 截断值（0.7）。使用对数秩检验比较 Kaplan-Meier 生存曲线，使用风险比（HR）和 95%置信区间（CI）测量治疗效果。

结果

本研究共纳入 132 例患者，根据截断值 0.7 将其分为 RDI<0.7 和 RDI≥0.7 组。RDI 分级是 OS 的独立预后因素。两组患者的基线人口统计学和临床特征均衡。没有证据表明 RDI<0.7 组患者的毒性更小，或 RDI≥0.7 组患者的毒性更大。然而，接受剂量减少的 RDI<0.7 患者的总生存情况更差[HR 0.49，95%CI 0.27-0.88，P=0.015]。随着剂量延迟时间的延长，RDI 较低的风险增加（P<0.001）。