老年cT1N0M0食管癌病人内镜和手术治疗预后分析：基于SEER数据库

A prognostic analysis on esophagectomy and endoscopic therapy for elderly patients with cT1N0M0 esophageal cancer: a SEER database

目的探讨手术治疗和内镜治疗对老年cT 1N0M0食管癌病人预后的影响。方法检索美国The Surveillance,Epidemiology,and End Results(SEER)数据库2004～2015年间年龄≥75岁的cT 1N0M0食管癌病人。入组病人分为两组:内镜治疗组(ET组)和食管癌切除术组(ES组)。寿命表法计算5年生存率(OS)和肿瘤特异性生存率(CSS),Kaplan-Meier法绘制生存曲线。采用COX比例风险模型分析病人预后影响因素。结果入组病人471例,ET组257例(54. 6%),ES组214例(45. 4%)。2004～2009年间到2010～2015年间,内镜治疗的应用增加(47. 8%和60. 8%),而手术治疗的比例下降(52. 2%和39. 2%),两个时间段比较,趋势均有统计学意义(P <0. 05);而两个时间段的5年OS(27. 4%和52. 0%)和CSS(58. 1%和78. 6%)均随时间的进展而提高(P <0. 05)。ET组、ES组总的5年OS(26. 0%和38. 2%)、CSS(65. 0%和61. 9%)比较差异均无统计学意义(P> 0. 05)。COX多因素回归分析显示,手术治疗相对于内镜治疗并没有改善病人的5年OS(HR:0. 763,95%CI:0. 573～1. 018,P> 0. 05)和CSS(HR:0. 991,95%CI:0. 648～1. 516,P> 0. 05)。结论老年早期cT 1N0M0的食管癌病人内镜治疗可行,且不影响此类病人的5年OS和CSS。

Objective To investigate the effect of surgical and endoscopic treatment on the prognosis of elderly patients with cT 1 N0 M0 esophageal cancer. Methods The Surveillance,Epidemiology,and End Results（ SEER） database was queried to identify elderly patients（ ≥75 years） with cT 1 N0 M0 esophageal cancer from 2004 to 2015. The enrolled patients were divided into two groups： esophagectomy（ group ES） and endoscopic therapy（ group ET） group. Five-year overall survival（ OS） and cancer-specific survival（ CSS） were compared using the life table method,Kaplan-Meier method was used to draw the survival curve. Multivariate Cox proportional hazards model was used to assess the importance of various covariates. Results Data from 471 esophageal cancer patients（ group ET： n = 257,54. 6%; group ES： n =214,45. 4%） were included. There was an increase in the proportion of patients who underwent ET from the year of 2004 - 2009（ 47. 8%） to 2010 - 2015（ 60. 8%）,while ES decreased from 52. 2% to 39. 2%（ both P〈0. 05）. There was also an increase in 5-year OS（ 27. 4% VS 52. 0%,P〈0. 05） and CSS（ 58. 1% VS 78. 6%,P〈0. 05） between the two time intervals. The 5-year OS of ES and ET groups were26. 0% VS 38. 2%（ P〉0. 05）,while CSS were 65. 0% VS 61. 9%（ P〉0. 05）. Multivariate Cox regression analysis showed that esophageal cancer patients who underwent ES did not improve 5-year OS（ HR：0. 763,95% CI： 0. 573 - 1. 018,P〉0. 05） or CSS（ HR： 0. 991,95% CI： 0. 648 - 1. 516,P〉0. 05） compared with those who underwent ET. Conclusion Endoscopic treatment of esophageal cancer patients with early cT 1 N0 M0 in the elderly is feasible and does not affect 5-year OS and CSS in such patients.