基于倾向评分匹配法评估进展期胃癌合并同时性原发食管癌综合治疗的临床疗效

Propensity score matching method evaluate the clinical efficacy of comprehensive treatment for synchronous pri⁃mary advanced gastric and esophageal cancer

目的:通过倾向评分匹配(propensity score matching,PSM)法评估进展期胃癌合并同时性原发食管癌综合治疗的临床疗效。方法:回顾性分析江苏省中医院2013年1月至2022年12月收治的2551例进展期胃癌病人,将其中45例合并同时性原发食管癌的病人纳入观察组,将2506例未合并食管癌的病人纳入对照组。采用PSM法匹配,获取组间协变量均衡样本;统计观察组治疗方案,对比组间的总生存(overall survival,OS)。结果:观察组和对照组各有45例样本纳入本研究。按治疗方案将观察组分为根治性切除组(n=22)和根治性放化疗(chemoradiotherapy,CRT)组(n=23)。根治性切除组中有4例行近端胃切除术联合Ivor Lewis手术同时切除食管肿瘤,18例行胃癌根治性切除联合食管癌内镜下黏膜下剥离术(endoscopic submucosal dissection,ESD)。根治性CRT组中均予以胃癌根治性切除术联合食管癌根治性CRT。生存分析显示观察组OS期明显短于对照组(P=0.042);根治性切除组与对照组之间OS率差异无统计学意义(P=0.799);根治性CRT组1、3、5年生存率明显低于对照组(P=0.003),而根治性切除组1、3、5年生存率与根治性CRT组相比,差异无统计学意义(P=0.071)。结论:多学科综合治疗能显著改善胃食管同时性双原发癌病人的预后。胃癌根治性切除联合食管癌ESD是胃癌合并早期食管癌病人可选的治疗方法,胃癌根治性切除联合食管癌CRT能改善进展期胃癌合并不可切除食管癌病人的预后。

Objective To evaluate the clinical efficacy of comprehensive treatment for synchronous primary advanced gastric and esophageal cancer by propensity score matching(PSM).Methods A total of 2551 patients with advanced gastric cancer admitted to Jiangsu Province Hospital of Chinese Medicine from January 2013 to December 2022 were retrospectively analyzed.Among them,45 patients with synchronous primary esophageal cancer were distributed to the observation group,and 2506 patients without esophageal cancer were distributed to the control group.Through the PSM method,the control group was matched with the observation group and the equilibrium samples of covariates between two groups were obtained.The overall survival(OS)between the two groups were compared.Results Both observation and control group contained 45 patients in this study.According to the treatment regimen,the patients in the observation group was divided into radical resection treatment subgroup(n=22)and chemoradiotherapy(CRT)subgroup(n=23).In the radical resection subgroup,4 patients underwent the simultaneous surgical resection of gastric and esophageal tumors through proximal gastrectomy with the Ivor Lewis operation.Eighteen patients underwent endoscopic submucosal dissection(ESD)of their esophageal tumors and gastric cancer radical resection.Radical resection of gastric cancer combined with preoperative chemoradiotherapy of esophageal cancer was performed in the CRT subgroup.Survival analysis showed that OS in the observation group was significantly shorter than that in the control group(P=0.042)and there was no significant difference in OS between the radical resection subgroup and the control group(P=0.799).The 1⁃,3⁃,and 5⁃year survival rates of the patients in the CRT subgroup were significantly lower than those of the control group(P=0.003).While the 1⁃,3⁃,and 5⁃year survival rates of the patients in the radical resection subgroup were not statistically significant,compared to those of the CRT subgroup(P=0.071).Conclusions Multidisciplinary and comprehensive treatment can significantly improve the prognosis of patients with synchronous primary advanced gastric and esophageal cancer.Radical resection of gastric cancer combined with ESD of esophageal cancer is an optional treatment for patients with gastric cancer complicated with early esophageal cancer.Radical resection of gastric cancer combined with CRT of esophageal cancer can improve the prognosis of patients with advanced gastric cancer complicated with unresectable esophageal cancer.