新辅助放疗与辅助放疗对T3N0期食管癌患者疗效的对比

Comparison of the efficacy of neoadjuvant radiotherapy and adjuvant radiotherapy for patients with T3N0 stage esophageal cancer

目的通过对美国SEER数据库2004—2014年收录的术前或术后行放疗的食管癌根治术患者资料,探讨新辅助放疗与辅助放疗对T3N0期行食管癌根治术患者疗效。方法将美国SEER数据库2004—2014年间收录的接受术前放疗或术后放疗的行食管癌根治术的555例T3N0期患者资料纳入研究,其中接受新辅助放疗的有486例(新辅助放疗组),接受术后辅助放疗的有69例(辅助放疗组)。分析并比较新辅助放疗与辅助放疗对T3N0期行食管癌根治术患者疗效,同时采用1∶1倾向性匹配方法分析两组患者的疗效。结果新辅助放疗组肿瘤特异性生存明显优于辅助放疗组(χ2=6.030,P<0.05);多因素COX回归分析提示年龄、性别及放疗顺序是影响预后的重要因素(Wald=10.099、10.562、4.331,P<0.05),其中辅助放疗组肿瘤特异性死亡风险及总体死亡风险分别是新辅助放疗组的1.649(95%CI 1.173~2.316,P=0.004)倍、1.402(95% CI 1.020~1.928,P=0.037)倍。1∶1倾向性匹配后分析提示,新辅助放疗组肿瘤特异性生存率明显优于辅助放疗组(χ2=6.293,P<0.05)。结论与术后辅助放疗相比,新辅助放疗能够改善T3N0期食管癌患者的预后,具有重要的临床价值。

Objective To compare the efficacy of neoadjuvant radiotherapy and adjuvant radiotherapy in the treatment of patients who underwent radical esophagectomy for T3N0 stage. Methods Totally 555 cases of T3N0, who underwent t neoadjuvant radiotherapy or adjuvant radiotherapy from 2004 to 2014, were selected from the SEER cancer registry in this study. 486 cases received neoadjuvant radiotherapy (neoadjuvant radiotherapy group) and 69 cases received adjuvant radiotherapy (adjuvant radiotherapy group). Kaplan-Meier (KM) survival and multivariate Cox regression analyses were used to analyze the overall survival (OS) and cancer specify survival (CSS) of the two groups. A propensity score model was utilized to balance the baseline covariates. Results The CSS in the neoadjuvant radiotherapy group was significantly better than that in the adjuvant radiotherapy group (χ2=6.030, P<0.05). Multivariate COX regression analysis showed that age, gender, and radiotherapy sequence with surgery were important factors influencing the prognosis of esophageal cancer with T3N0 stage (Wald=10.099, 10.562, 4.331, P<0.05). Compared with the neoadjuvant radiotherapy group, the adjuvant radiotherapy group had a worse CSS (hazard ratio: 1.649, 95%CI 1.173-2.316, P=0.004) and OS (hazard ratio: 1.402, 95%CI 1.020-1.928, P=0.037). According to K-M survival analysis, the adjuvant radiotherapy group showed the worse CSS (hazard ratio: 1.813, 95%CI 1.072-3.069, P=0.027) and OS (hazard ratio: 1.424, 95% CI 0.896-2.262, P=0.134) than the neoadjuvant radiotherapy in esophageal cancer with T3N0 stage, which was similar to the matched cohort. Conclusions Compared with postoperative adjuvant radiotherapy, neoadjuvant radiotherapy significantly improves the CSS and OS of T3N0 patients with esophageal cancer.