Kamtam Devanish N, Lin Nicole, Liou Douglas Z, Lui Natalie S, Backhus Leah M, Shrager Joseph B, Berry Mark F
Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
Department of General Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif.
JTCVS Open. 2024 Nov 14;23:290-308. doi: 10.1016/j.xjon.2024.11.001. eCollection 2025 Feb.
Radiation after esophagectomy may cause conduit dysfunction with unclear oncologic benefits. We hypothesized that adjuvant chemoradiation does not improve survival over chemotherapy alone for patients with pathologic upstaging after primary surgery for cT1-2N0M0 esophageal adenocarcinoma.
The impact of adjuvant therapy after primary surgery for cT1-2N0M0 esophageal adenocarcinoma upstaged to pT3-4 or pN+ in the National Cancer Database (2004-2019) was evaluated with logistic regression, Kaplan-Meier analysis, and Cox modeling.
A total of 574 patients met inclusion criteria, 300 (52.3%) who received adjuvant therapy (chemotherapy alone in 117 [39.0%], radiation alone in 15 [5.0%], chemoradiation in 168 [56.0%]) and 274 (47.7%) who did not. Adjuvant therapy was associated with improved 5-year survival (46.8% vs 32.7%, < .001). In multivariate analysis controlling for age, year of diagnosis, Charlson Comorbidity Index, pT, pN, and positive margins, adjuvant chemotherapy was independently associated with improved survival (hazard ratio, 0.62, 95% CI, 0.46-0.84, = .002); radiation use did not have a statistically significant association with survival (hazard ratio, 1.19, 95% CI, 0.86-1.63, = .29). Among patients who received chemotherapy, independent predictors of also receiving radiotherapy included pathological T-upstaging (odds ratio, 2.01, 95% CI, 1.04-3.88, = .037) and distance from facility less than 50 miles (odds ratio, 2.13, 95% CI, 1.05-4.33, = .037). In univariate analysis of patients who received adjuvant therapy, chemotherapy alone was associated with significantly better 5-year survival compared with chemoradiation (54.2% vs 41.6%, = .004). Landmark analyses at 3 and 6 months were consistent with the primary analysis.
Using radiation with chemotherapy as adjuvant therapy for patients upstaged after esophagectomy for cT1-2N0 esophageal adenocarcinoma is not associated with improved survival and should be considered only in select situations based on careful clinical evaluation.
食管癌切除术后放疗可能导致管道功能障碍，而肿瘤学获益尚不明确。我们推测，对于cT1-2N0M0食管腺癌初次手术后病理分期上调的患者，辅助放化疗并不比单纯化疗更能提高生存率。
利用逻辑回归、Kaplan-Meier分析和Cox模型，评估国家癌症数据库（2004 - 2019年）中cT1-2N0M0食管腺癌初次手术后分期上调至pT3-4或pN+的患者接受辅助治疗的影响。
共有574例患者符合纳入标准，300例（52.3%）接受了辅助治疗（单纯化疗117例[39.0%]，单纯放疗15例[5.0%]，放化疗168例[56.0%]），274例（47.7%）未接受辅助治疗。辅助治疗与5年生存率提高相关（46.8%对32.7%，P<0.001）。在多变量分析中，控制年龄、诊断年份、Charlson合并症指数、pT、pN和切缘阳性后，辅助化疗与生存率提高独立相关（风险比，0.62，95%CI，0.46 - 0.84，P = 0.002）；放疗的使用与生存率无统计学显著关联（风险比，1.19，95%CI，0.86 - 1.63，P = 0.29）。在接受化疗的患者中，同时接受放疗的独立预测因素包括病理T分期上调（比值比，2.01，95%CI，1.04 - 3.88，P = 0.037）和距离医疗机构小于50英里（比值比，2.13，95%CI，1.05 - 4.33，P = 0.037）。在接受辅助治疗患者的单变量分析中，单纯化疗与5年生存率显著高于放化疗相关（54.2%对41.6%，P = 0.004）。3个月和6个月的标志性分析与初步分析一致。
对于cT1-2N0食管腺癌食管癌切除术后分期上调的患者，使用放疗联合化疗作为辅助治疗与生存率提高无关，应仅在基于仔细临床评估的特定情况下考虑。
