Impact of Postoperative Radiation after Esophagectomy for Esophageal Cancer
Impact of Postoperative Radiation after Esophagectomy for Esophageal Cancer
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DOI：
10.1097/jto.0b013e3181c5e34f
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发表时间：
2010-02-01
影响因子：
20.4
通讯作者：
Rotman, Marvin
中科院分区：
文献类型：
--
作者：
Schreiber, David;Rineer, Justin;Rotman, Marvin
简介：虽然食管癌的术后放射治疗是在选定的情况下提供的，但关于它是否能提高总生存率（OS），仍有相互矛盾的证据。我们使用监测流行病学和最终结果数据库进行了回顾性分析，以分析辅助放疗对大型患者队列的影响。方法：从1998年至2005年，确诊为T3- 4 N 0 M0或T1- 4 N1 M0期食管腺癌（AC）或鳞状细胞癌（SCC）并接受食管切除术（伴或不伴术后放疗）的患者，被选中。结果：1046例患者中，683例（65.3%）接受单纯手术，363例（34.7%）接受术后放疗，两组患者的生存率和疾病特异性生存率（DSS）分别为10.0%和10.0%。对于美国癌症联合委员会III期食管癌（T3 N1 M0或T4 N 0 - 1 M0），中位和3年OS（p < 0.001）和DSS（p < 0.001）分别有显著改善。SCC和AC均存在这种益处。然而，对于美国癌症联合委员会IIA和IIB期疾病，OS或DSS没有显著差异。多变量分析显示，术后放疗是改善OS的最重要预测因素（风险比0.70，95%置信区间0.59-0.83，p < 0.001）。结论：这项基于大量人群的综述支持使用术后放疗治疗食管III期SCC和AC。鉴于本研究的回顾性性质，在适当把握度的随机试验证实这些结果之前，在临床实践中广泛应用这些发现之前应谨慎使用。
Introduction: Though postoperative radiation for esophageal cancer is offered in selected cases, there is conflicting evidence as to whether it improves overall survival (OS). We performed a retrospective analysis using the Surveillance Epidemiology and End Results database to analyze the impact of adjuvant radiation in a large cohort of patients.Methods: From 1998 to 2005, patients diagnosed with stage T3-4N0M0 or T1-4N1M0 esophageal adenocarcinoma (AC) or squamous cell carcinoma (SCC) who were definitively treated with esophagectomy, with or without postoperative radiation, were selected. Kaplan-Meier and Cox regression analysis were used to compare OS and disease-specific survival (DSS).Results: A total of 1046 patients met the selection criteria: 683 (65.3%) received Surgery alone and 363 (34.7%) received postoperative radiation. For American Joint Committee on Cancer stage III esophageal carcinoma (T3N1M0 or T4N0-1M0), there was significant improvement in median and 3-year OS (p < 0.001) and DSS (p < 0.001), respectively. This benefit was present for both SCC and AC. However, for American Joint Committee on Cancer stages IIA and IIB disease there was no significant differences in OS or DSS. Multivariate analysis revealed that postoperative radiation was the most significant predictor for improved OS (hazard ratio 0.70, 95% confidence interval 0.59-0.83, p < 0.001).Conclusions: This large population-based review supports the use of postoperative radiation for stage III SCC and AC of the esophagus. Given the retrospective nature of this study, until appropriately powered randomized trials confirm these results, caution should be used before broadly applying these findings in clinical practice.