Cao Yuqin, Hu Qingqing, Zhang Yajie, Li Chengqiang, Zhou Yuan, Zhang Yongjing, Qiu Hong, Li Hecheng
Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Global Epidemiology, Office of Chief Medical Officer, Johnson & Johnson, Shanghai, China.
J Thorac Dis. 2024 Oct 31;16(10):6651-6663. doi: 10.21037/jtd-24-806. Epub 2024 Oct 29.
Esophageal squamous cell carcinoma (ESCC) is common in China and has a poor prognosis despite radical surgery. Guidelines around the use of adjuvant therapy (AT) in ESCC are indecisive. We assessed the benefit of AT on recurrence-free survival (RFS) in Chinese patients with ESCC using propensity score (PS) matching.
This retrospective cohort study used hospital electronic medical records (EMRs) of 523 adults diagnosed between 2013 to 2019 with pathologically confirmed ESCC after R0 esophagectomy without neoadjuvant therapy. PSs were calculated using a generalized linear regression model based on demographic, clinical, and pathologic features. Patients with and without AT were matched using nearest neighbor method and caliper value 0.05. Subgroup analyses were stratified by PS.
Younger patients with more advanced/poorly differentiated disease were more likely to receive AT (P<0.05). There were 137 matched pairs in the AT/No AT groups. After matching, the AT group tended to have longer median RFS [95% confidence interval (CI): 2.21 years (1.54-3.20)] than the No AT group [1.75 years (1.37-2.21)] (P=0.18). The benefit was significant in patients with PS ≥0.40 [hazard ratio 0.55, 95% CI: 0.32-0.87, median RFS (95% CI): 2.22 years (1.30-3.52) versus 1.23 years (0.90-1.64), P=0.03]. In other PS subgroups, median RFS was similar in AT and No AT groups.
After adjusting for baseline characteristics, AT tended to improve RFS after R0 esophagectomy in Chinese patients, with significant benefit associated with a higher PS score. The utility of PS to guide patient selection for AT in clinical practice needs further investigation.
食管鳞状细胞癌（ESCC）在中国很常见，尽管进行了根治性手术，但其预后仍很差。关于ESCC辅助治疗（AT）使用的指南并不明确。我们使用倾向评分（PS）匹配评估了AT对中国ESCC患者无复发生存期（RFS）的益处。
这项回顾性队列研究使用了2013年至2019年间523名成人的医院电子病历（EMR），这些患者经病理确诊为ESCC，接受了R0食管切除术后未进行新辅助治疗。使用基于人口统计学、临床和病理特征的广义线性回归模型计算PS。使用最近邻法和卡尺值0.05对接受和未接受AT的患者进行匹配。亚组分析按PS分层。
年龄较小、疾病分期较晚/分化较差的患者更有可能接受AT（P<0.05）。AT/非AT组有137对匹配对。匹配后，AT组的中位RFS往往长于非AT组[95%置信区间（CI）：2.21年（1.54 - 3.20）]，非AT组为[1.75年（1.37 - 2.21）]（P = 0.18）。在PS≥0.40的患者中，益处显著[风险比0.55，95%CI：0.32 - 0.87，中位RFS（95%CI）：2.22年（1.30 - 3.52）对1.23年（0.90 - 1.64），P = 0.03]。在其他PS亚组中，AT组和非AT组的中位RFS相似。
在调整基线特征后，AT倾向于改善中国患者R0食管切除术后的RFS，较高的PS评分与显著益处相关。PS在临床实践中指导患者选择AT的效用需要进一步研究。
