Ryu Dae Gon, Yun Mi Sook, Liu Hongqun, Lee Samuel S, Lee Sangjune Laurence
Liver Unit, University of Calgary Cumming School of Medicine, Calgary, AB, Canada.
Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
Clin Transl Radiat Oncol. 2024 Jul 7;48:100817. doi: 10.1016/j.ctro.2024.100817. eCollection 2024 Sep.
Alcohol consumption is a strong risk factor for both cirrhosis and esophageal squamous cell carcinoma (ESCC). Few studies have been conducted on the treatment of ESCC in patients with cirrhosis. This study aimed to analyze the clinical outcomes of ESCC in patients with cirrhosis.
Medical records of patients with esophageal cancer between January 2009 and December 2023 were retrospectively reviewed. A total of 479 patients with ESCC were included and divided into cirrhotic (n = 69) and non-cirrhotic (n = 410) groups. Clinical outcomes and survival according to treatment were compared between these groups.
The cirrhotic group was younger (median age 64 years vs. 69 years, = 0.022) and had a higher proportion of male (97.1 % vs. 88.3 %, = 0.042) than the non-cirrhotic group. Patients with cirrhosis were less likely to undergo surgery (31.9 % vs. 47.8 %, = 0.015) and were more likely to receive no active cancer treatment (26.1 % vs. 13.7 %, = 0.010). Overall survival was lower in the cirrhotic group (hazard ratio [HR], 1.41; 95 % confidence interval [CI], 1.01-1.99; = 0.045), however, no difference was found between Child-Pugh class A patients and those in the non-cirrhotic group (HR, 1.04 [95 % CI, 0.69-1.56]; = 0.864). Postoperative mortality was significantly higher in cirrhotic group (27.3 % vs. 8.7 %, = 0.011). Upon performing concurrent chemoradiotherapy (CRT), the clinical complete response rate (84.2 % vs. 43.3 %, = 0.004) was better in the cirrhotic group. CRT yielded better overall survival for patients with cancer in the resectable stages in the cirrhotic group compared to surgery (HR, 0.19 [95 % CI, 0.42-0.84]; = 0.029].
In patient with ESCC and cirrhosis, chemoradiotherapy may be a better treatment option than surgery.
饮酒是肝硬化和食管鳞状细胞癌（ESCC）的重要危险因素。关于肝硬化患者ESCC治疗的研究较少。本研究旨在分析肝硬化患者ESCC的临床结局。
回顾性分析2009年1月至2023年12月食管癌患者的病历。共纳入479例ESCC患者，分为肝硬化组（n = 69）和非肝硬化组（n = 410）。比较两组患者根据治疗情况的临床结局和生存率。
肝硬化组患者比非肝硬化组更年轻（中位年龄64岁 vs. 69岁，P = 0.022），男性比例更高（97.1% vs. 88.3%，P = 0.042）。肝硬化患者接受手术的可能性较小（31.9% vs. 47.8%，P = 0.015），更有可能未接受积极的癌症治疗（26.1% vs. 13.7%，P = 0.010）。肝硬化组的总生存率较低（风险比[HR]，1.41；95%置信区间[CI]，1.01 - 1.99；P = 0.045），然而，Child-Pugh A级患者与非肝硬化组患者之间未发现差异（HR，1.04[95%CI，0.69 - 1.56]；P = 0.864）。肝硬化组术后死亡率显著更高（27.3% vs. 8.7%，P = 0.011）。在进行同步放化疗（CRT）时，肝硬化组的临床完全缓解率更好（84.2% vs. 43.3%，P = 0.004）。与手术相比，CRT使肝硬化组可切除阶段癌症患者的总生存率更高（HR，0.19[95%CI，0.42 - 0.84]；P = 0.029）。
对于ESCC合并肝硬化的患者，放化疗可能是比手术更好的治疗选择。
