Gong Cheng, Wang Zhidong, Chao Ce, Wang Min, Qian Yongxiang, Di Dongmei, Liu Yang
Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China.
Transl Cancer Res. 2025 May 30;14(5):2615-2625. doi: 10.21037/tcr-24-2099. Epub 2025 May 20.
Esophageal cancer (EC) is an aggressive gastrointestinal carcinoma with high morbidity and mortality worldwide. This study was aimed at investigating the influences of T stage in patients with the same III/IV stage, and of various therapeutic modalities in each subgroup of III/IV stage in esophageal adenocarcinoma (EAC).
Patients diagnosed with EAC between 2000 and 2019 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox regression models were used to select independent prognostic factors associated with overall survival (OS) and cancer-specific survival (CSS). Kaplan-Meier survival curves were used to determine survival differences according to T stage and treatment strategy in the III/IV stage subgroup.
Data from 5,765 EACs were identified. Seven independent risk factors were identified for OS and CSS. Based on T stage, patients with the same III/IV stage showed survival differences in the subgroup analyses in both OS and CSS (P<0.001). The median survival time in T2N1M0 in III stage and T1N2-3M0 in IVA stage was longer compared to the other groups, respectively. Concerning therapy modalities, chemotherapy alone or surgery alone showed a significant difference in terms of CSS in III stage subgroups (P<0.001, P=0.01, respectively), while surgery combined with chemotherapy also showed a significant difference (P=0.02). However, no survival difference was found in the subgroups of IVA stage based on therapy. Finally, chemotherapy plus surgery in early stages of III/IVA subgroups prominently increased the median survival time.
Differences according to T stage may potentially influence EAC survival under the same III/IV stage. Our findings implied that higher T stage was associated with poorer prognosis among patients in the same III/IVA stage. Meanwhile, it was advised for patients to receive surgery plus chemotherapy in the early subgroups of III/IVA stage.
食管癌（EC）是一种侵袭性胃肠道癌，在全球范围内发病率和死亡率都很高。本研究旨在调查相同III/IV期患者中T分期的影响，以及食管腺癌（EAC）III/IV期各亚组中不同治疗方式的影响。
从监测、流行病学和最终结果（SEER）数据库中提取2000年至2019年诊断为EAC的患者。使用单因素和多因素Cox回归模型选择与总生存期（OS）和癌症特异性生存期（CSS）相关的独立预后因素。采用Kaplan-Meier生存曲线来确定III/IV期亚组中根据T分期和治疗策略的生存差异。
共识别出5765例EAC患者的数据。确定了7个与OS和CSS相关的独立危险因素。基于T分期，相同III/IV期的患者在OS和CSS的亚组分析中均显示出生存差异（P<0.001）。III期T2N1M0和IVA期T1N2-3M0的中位生存时间分别比其他组更长。关于治疗方式，在III期亚组中，单纯化疗或单纯手术在CSS方面显示出显著差异（分别为P<0.001，P=0.01），而手术联合化疗也显示出显著差异（P=0.02）。然而，在IVA期亚组中，基于治疗方式未发现生存差异。最后，III/IVA亚组早期进行化疗加手术显著延长了中位生存时间。
在相同的III/IV期，T分期差异可能会影响EAC的生存。我们的研究结果表明，在相同的III/IVA期患者中，较高的T分期与较差的预后相关。同时，建议III/IVA期早期亚组的患者接受手术加化疗。
