Immunologic Consequences of Sequencing Cancer Radiotherapy and Surgery
Immunologic Consequences of Sequencing Cancer Radiotherapy and Surgery
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DOI：
10.1200/cci.18.00075
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发表时间：
2019-04-09
影响因子：
4.2
通讯作者：
Enderling, Heiko
中科院分区：
文献类型：
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作者：
Alfonso, Juan Carlos Lopez;Poleszczuk, Jan;Enderling, Heiko
目的早期癌症的常规治疗方法是先手术后放射治疗。对于某些癌症，术前放射治疗(RS)已被广泛忽视。我们用SR和RS评估不同癌症类型的总生存期(OS)和疾病远期生存率(DFS)，并模拟RS和SR诱导的抗肿瘤免疫对结果的影响。材料与方法我们分析了SR或RS治疗的早期癌症的SEER数据集。对于具有足够统计能力的癌症(肺癌、支气管癌、食道癌、直肠癌、子宫颈癌、子宫癌和乳腺癌)，计算OS和DFS。我们在一个肿瘤免疫相互作用的数学模型中模拟了SR、RS和放射治疗的免疫学后果。结果RS改善了20年生存率低的癌症(肺：风险比[HR]，0.88；P=.046)的OS，改善了生存率较高的癌症(乳腺癌：HR=0.64；P
PURPOSE Early-stage cancers are routinely treated with surgery followed by radiotherapy (SR). Radiotherapy before surgery (RS) has been widely ignored for some cancers. We evaluate overall survival (OS) and diseasefree survival (DFS) with SR and RS for different cancer types and simulate the plausibility of RS- and SR-induced antitumor immunity contributing to outcomes.MATERIALS AND METHODS We analyzed a SEER data set of early-stage cancers treated with SR or RS. OS and DFS were calculated for cancers with sufficient numbers for statistical power (cancers of lung and bronchus, esophagus, rectum, cervix uteri, corpus uteri, and breast). We simulated the immunologic consequences of SR, RS, and radiotherapy alone in a mathematical model of tumor-immune interactions.RESULTS RS improved OS for cancers with low 20-year survival rates (lung: hazard ratio [HR], 0.88; P = .046) and improved DFS for cancers with higher survival (breast: HR = 0.64; P