Benefit of postoperative adjuvant chemoradiotherapy in locoregionally advanced esophageal carcinoma
Benefit of postoperative adjuvant chemoradiotherapy in locoregionally advanced esophageal carcinoma
复制标题
DOI：
10.1016/s0022-5223(03)01025-0
复制
发表时间：
2003-11-01
影响因子：
6
通讯作者：
Blackstone, EH
中科院分区：
文献类型：
--
作者：
Rice, TW;Adelstein, DJ;Blackstone, EH
目的：我们试图确定食管切除术后的放化疗是否能提高生存率。方法：从1994年至2000年，31例局部晚期食管癌（90%pT3，81%pN1和13%pM1a）接受术后辅助放化疗。同时，52名晚期癌症患者接受了单独的食管切除术，并存活了至少10周，这是辅助治疗的时间范围。基于人口统计学、肿瘤和手术因素的倾向评分用于识别匹配对，以确定辅助治疗与结果的关联。对于接受辅助治疗与单纯食管切除术的患者，未校正风险的中位、1年和4年生存期分别为28个月与14个月，68% +/- 8.4%与60% +/-6.8%，分别为44% +/- 9.0%和11% +/-5.6%（P =.05）。同样，未调整风险的中位复发时间为25个月对13个月（P = 0.15），中位无复发生存期为22个月对11个月（P= 0.04）。在倾向匹配的患者中，接受辅助治疗与食管切除术的中位、1年和4年生存率分别为28个月与15个月，60% +/- 11.0%与65% +/-10.7%，44% +/- 11.3%与0%（P = 0.05）。中位复发时间为25个月对13个月（P = .04），无复发生存期为22个月对10个月（P = .02）。结论：在局部晚期食管癌患者中，在单纯食管切除术的基础上增加术后辅助放化疗可使生存时间、复发时间和无复发生存期增加一倍。食管切除术后局部晚期癌患者应考虑进行辅助治疗。
Objective: We sought to determine whether chemoradiotherapy after esophagectomy improves survival.Methods: From 1994 to 2000, 31 patients with locoregionally advanced esophageal carcinoma (90% pT3, 81% pN1, and 13% pM1a) received postoperative adjuvant chemoradiotherapy. Concurrently, 52 patients with advanced carcinoma underwent esophagectomy alone and survived at least 10 weeks, the time frame for adjuvant therapy. A propensity score based on demographic, tumor, and surgical factors was used to identify matched pairs to determine the association of adjuvant therapy with outcomes.Results: For patients receiving adjuvant therapy versus esophagectomy alone, risk-unadjusted median, 1-year, and 4 year survivals were 28 versus 14 months, 68% +/- 8.4% versus 60% +/- 6.8%, and 44% +/- 9.0% versus 11% +/- 5.6%, respectively (P =.05). Similarly, risk-unadjusted median time to recurrence was 25 versus 13 months (P =.15), and median recurrence-free survival was 22 versus I I months (P=.04). Among propensity-matched patients, median, 1-year, and 4-year survivals for those receiving adjuvant therapy versus esophagectomy were 28 versus 15 months, 60% +/- 11.0% versus 65% +/- 10.7%, and 44% +/- 11.3% versus 0% (P =.05). Median time to recurrence was 25 versus 13 months (P = .04), and recurrence-free survival was 22 versus 10 months (P = .02).Conclusion: In patients with locoregionally advanced esophageal carcinoma, addition of postoperative adjuvant chemoradiotherapy to esophagectomy alone doubled survival time, time to recurrence, and recurrence-free survival. Patients with locoregionally advanced carcinoma after esophagectomy should be considered for adjuvant therapy.