Outcome of patients receiving radiation for cancer of the esophagus: Results of the 1992-1994 patterns of care study
Outcome of patients receiving radiation for cancer of the esophagus: Results of the 1992-1994 patterns of care study
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DOI：
10.1200/jco.2000.18.3.455
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发表时间：
2000-02-01
影响因子：
45.3
通讯作者：
Hanks, GE
中科院分区：
文献类型：
--
作者：
Coia, LR;Minsky, BD;Hanks, GE
目的：一项护理模式研究检查了1992年至1994年接受放射治疗的食管癌（EC）患者的记录，以确定全国护理实践过程和结果，并将结果与临床试验结果进行比较。采用两阶段整群抽样对63个机构进行了全国性调查，并收集了400名胸段食管鳞状细胞癌（62%）或腺癌（37%）患者的具体信息，这些患者接受了放射治疗（RT）作为主要或辅助治疗的一部分。根据1983年美国癌症联合委员会的分期系统对患者进行分期。15%的患者患有临床分期（CS）I期疾病，40%患有CS II期疾病，30%患有CS III期疾病。26%的患者接受了食管切除术。75%的患者接受了化疗;其中84%的患者接受了同步化疗和放疗（CRT）。多变量分析中影响总生存率的重要变量包括食管切除术的使用（风险比[RR] = 0.62），使用化疗（RR = 0.63）、Karnofsky体力状态（KPS）大于80（RR = 0.61）、CS I或II疾病（RR = 0.66）和设施类型（RR = 0.72）。年龄、性别和组织学差异无统计学意义。术前CRT的1年生存率与单纯CRT相比无统计学意义（63% v39%; P = 0.11），而按计划治疗而非给予治疗的2年生存率术前CRT为47.7%，明确CRT为35.4%（P = 0.23）。与确定性PT单独治疗相比，连续性CRT显著提高了2年生存率（39% v20.6%; P = 0.027）和降低了5年局部区域失败率（30% v57.9%; P = 0.0031）。结论：本研究证实了CRT在EC治疗中的价值。这表明，在全国范围内的实践环境中获得的结果是相似的，在临床试验中获得的KPS和1983年的临床分期系统是有用的预后指标。在这项研究中，食管切除术的建议价值和术前CRT优于单独CRT的优越性应在随机试验中进行检验。J Clin Oncol 18：455-462. (C)2000年，美国临床肿瘤学会。
Purpose: A patterns of Care Study examined the records of patients with esophageal cancer (EC) treated with radiation in 1992 through 1994 to determine the national practice processes of care and outcomes and to compare the results with those of clinical trials.Patients and Methods: A national survey of 63 institutions was conducted using two-stage cluster sampling, and specific information was collected on 400 patients with squamous cell (62%) or adenocarcinoma (37%) of the thoracic esophagus who received radiation therapy (RT) as part of primary or adjuvant treatment. Patients were staged according to a modified 1983 American Joint Committee on Cancer staging system. Fifteen percent of patients had clinical stage (CS) I disease, 40% had CS II disease, and 30% had CS III disease. Twenty-six percent of patients underwent esophagectomy. Seventy-five percent of patients received chemotherapy; 84% of these received concurrent chemotherapy and radiation (CRT).Results: Significant variables for overall survival in multivariate analysis include the use of esophagectomy (risk ratio [RR] = 0.62), the use of chemotherapy (RR = 0.63), Karnofsky performance status (KPS) greater than 80 (RR = 0.61), CS I or II disease (RR = 0.66), and facility type (RR = 0.72). Age, sex, and histology were not significant, Preoperative CRT resulted in a nonsignificantly higher a-year survival rate compared with definitive CRT alone (63% v 39%; P = .11), whereas 2-year survival by planned treatment rather than treatment given was 47.7% for preoperative CRT and 35.4% for definitive CRT (P = .23). Definitive CRT compared with definitive PT alone resulted in significantly higher 2-year survival (39% v 20.6%; P = .027) and lower 5-year local regional failure (30% v 57.9%; P = .0031).Conclusion: This study confirms the value of CRT in EC treatment. It indicates that the results obtained in practice settings nationwide are similar to those obtained in clinical trials and that KPS and the 1983 clinical staging system are useful prognostic indicators. The suggested value of esophagectomy and superiority of preoperative CRT over CRT alone in this study should be tested in a randomized trial. J Clin Oncol 18:455-462. (C) 2000 by American Society of Clinical Oncology.