BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the compa...BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the comparative efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC remain unclear.AIM To compare the efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC.METHODS We retrospectively analyzed the hospitalized data of a total of 472 consecutive patients with cT1N0M0 EC treated at Sun Yat-sen University Cancer center between 2017-2019 and followed up until October 30th,2022.We analyzed demographic,medical recorded,histopathologic characteristics,imaging and endoscopic,and follow-up data.The Kaplan-Meier method and Cox proportional hazards modeling were used to analyze the difference of survival outcome by treatments.Inverse probability of treatment weighting(IPTW)was used to minimize potential confounding factors.RESULTS We retrospectively analyzed patients who underwent ESD(n=99)or surgery(n=220)or d-CRT(n=16)at the Sun Yat-sen University Cancer Center from 2017 to 2019.The median follow-up time for the ESD group,the surgery group,and the d-CRT group was 42.0 mo(95%CI:35.0-60.2),45.0 mo(95%CI:34.0-61.75)and 32.5 mo(95%CI:28.3-40.0),respectively.After adjusting for background factors using IPTW,the highest 3-year overall survival(OS)rate and 3-year recurrence-free survival(RFS)rate were observed in the ESD group(3-year OS:99.7% and 94.7% and 79.1%;and 3-year RFS:98.3%,87.4% and 79.1%,in the ESD,surgical,and d-CRT groups,respectively).There was no difference of severe complications occurring between the three groups(P≥0.05).Multivariate analysis showed that treatment method,histology and depth of infiltration were independently associated with OS and RFS.CONCLUSION For cT1N0M0 EC,ESD had better long-term survival and lower hospitalization costs than those who underwent d-CRT and surgery,with a similar rate of severe complications occurring.展开更多
目的探讨新辅助化疗及改良根治术后放疗对cT1~2N1M0期乳腺癌患者预后的影响。方法通过提取美国国立癌症研究所监测、流行病学和结果(The Surveillance,Epidemiology,and End Results,SEER)数据库2010年至2017年期间诊断的已行新辅助化...目的探讨新辅助化疗及改良根治术后放疗对cT1~2N1M0期乳腺癌患者预后的影响。方法通过提取美国国立癌症研究所监测、流行病学和结果(The Surveillance,Epidemiology,and End Results,SEER)数据库2010年至2017年期间诊断的已行新辅助化疗及改良根治术的cT1~2N1M0期乳腺癌患者917例,采用倾向性评分匹配法将720例匹配患者分为放疗组(n=360)和未放疗组(n=360)。采用Cox比例风险回归模型探索影响乳腺癌特异性生存(breast cancer specific survival rate,BCSS)的影响因素。结果本研究患者均获访,中位随访时间为65个月,放疗组的5年BCSS率为91.9%,未放疗组为93.2%,差异无统计学意义(χ^(2)=0.292,P=0.589),在腋窝淋巴结未转移、腋窝淋巴结转移1枚、腋窝淋巴结转移2枚、腋窝淋巴结转移3枚患者中均是如此(χ^(2)=0.139,P=0.709;χ^(2)=0.578,P=0.447;χ^(2)=2.617,P=0.106;χ^(2)=0.062,P=0.803)。多因素Cox比例风险回归分析结果显示:在控制Grade分级、诊断到治疗的时间、新辅助化疗疗效、腋窝淋巴结阳性数、分子分型和初诊肿瘤直径后,放疗对BCSS的影响无统计学意义[HR=1.048,95%CI(0.704,1.561),P=0.817]。结论放疗对已行新辅助化疗及改良根治术后腋窝淋巴结转移0~3枚的cT1~2N1M0期乳腺癌患者BCSS的影响价值有限,但是否行放疗仍需根据肿瘤患者个体的综合风险来决定。展开更多
目的明确新辅助治疗在cT2N0期可切除食管癌患者中的临床意义。方法通过网上检索包括PubMed、Web of Science、EMBASE、the Cochrane Library、中国知网等一系列数据库,筛选符合本研究目的的真实世界研究,从中提取包括生存率、病理分期...目的明确新辅助治疗在cT2N0期可切除食管癌患者中的临床意义。方法通过网上检索包括PubMed、Web of Science、EMBASE、the Cochrane Library、中国知网等一系列数据库,筛选符合本研究目的的真实世界研究,从中提取包括生存率、病理分期改变、切缘阳性、术后吻合口瘘等多种结局指标。通过RevMan 5.4与R version 4.0.2等数据分析软件对其进行荟萃分析。结果累计筛选出7项研究,共4602例cT2N0食管癌患者纳入分析,荟萃分析表明新辅助联合手术治疗组(NS)与单纯手术组(S)在5年生存率、无复发生存率、术后吻合口瘘发生率与病理升期方面差异均无统计学意义(P>0.05);然而两组在术中切缘阳性以及病理降期上差异均有统计学意义(P<0.05)。结论新辅助治疗联合手术较单纯手术并未给cT2N0食管癌患者带来明显生存获益及更高的吻合口瘘风险,也未降低病理升期风险,但应用新辅助治疗可有效降低病理分期以及术中切缘阳性的概率。推荐对于检查完善且胃镜病理提示不含高危因素的cT2N0食管癌患者可直接行手术治疗。展开更多
基金Supported by the Guangdong Esophageal Cancer Institute Science and Technology Program,No.M202013Guangdong Medical Research Foundation,No.A2021369.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the comparative efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC remain unclear.AIM To compare the efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC.METHODS We retrospectively analyzed the hospitalized data of a total of 472 consecutive patients with cT1N0M0 EC treated at Sun Yat-sen University Cancer center between 2017-2019 and followed up until October 30th,2022.We analyzed demographic,medical recorded,histopathologic characteristics,imaging and endoscopic,and follow-up data.The Kaplan-Meier method and Cox proportional hazards modeling were used to analyze the difference of survival outcome by treatments.Inverse probability of treatment weighting(IPTW)was used to minimize potential confounding factors.RESULTS We retrospectively analyzed patients who underwent ESD(n=99)or surgery(n=220)or d-CRT(n=16)at the Sun Yat-sen University Cancer Center from 2017 to 2019.The median follow-up time for the ESD group,the surgery group,and the d-CRT group was 42.0 mo(95%CI:35.0-60.2),45.0 mo(95%CI:34.0-61.75)and 32.5 mo(95%CI:28.3-40.0),respectively.After adjusting for background factors using IPTW,the highest 3-year overall survival(OS)rate and 3-year recurrence-free survival(RFS)rate were observed in the ESD group(3-year OS:99.7% and 94.7% and 79.1%;and 3-year RFS:98.3%,87.4% and 79.1%,in the ESD,surgical,and d-CRT groups,respectively).There was no difference of severe complications occurring between the three groups(P≥0.05).Multivariate analysis showed that treatment method,histology and depth of infiltration were independently associated with OS and RFS.CONCLUSION For cT1N0M0 EC,ESD had better long-term survival and lower hospitalization costs than those who underwent d-CRT and surgery,with a similar rate of severe complications occurring.
文摘目的探讨新辅助化疗及改良根治术后放疗对cT1~2N1M0期乳腺癌患者预后的影响。方法通过提取美国国立癌症研究所监测、流行病学和结果(The Surveillance,Epidemiology,and End Results,SEER)数据库2010年至2017年期间诊断的已行新辅助化疗及改良根治术的cT1~2N1M0期乳腺癌患者917例,采用倾向性评分匹配法将720例匹配患者分为放疗组(n=360)和未放疗组(n=360)。采用Cox比例风险回归模型探索影响乳腺癌特异性生存(breast cancer specific survival rate,BCSS)的影响因素。结果本研究患者均获访,中位随访时间为65个月,放疗组的5年BCSS率为91.9%,未放疗组为93.2%,差异无统计学意义(χ^(2)=0.292,P=0.589),在腋窝淋巴结未转移、腋窝淋巴结转移1枚、腋窝淋巴结转移2枚、腋窝淋巴结转移3枚患者中均是如此(χ^(2)=0.139,P=0.709;χ^(2)=0.578,P=0.447;χ^(2)=2.617,P=0.106;χ^(2)=0.062,P=0.803)。多因素Cox比例风险回归分析结果显示:在控制Grade分级、诊断到治疗的时间、新辅助化疗疗效、腋窝淋巴结阳性数、分子分型和初诊肿瘤直径后,放疗对BCSS的影响无统计学意义[HR=1.048,95%CI(0.704,1.561),P=0.817]。结论放疗对已行新辅助化疗及改良根治术后腋窝淋巴结转移0~3枚的cT1~2N1M0期乳腺癌患者BCSS的影响价值有限,但是否行放疗仍需根据肿瘤患者个体的综合风险来决定。
文摘目的明确新辅助治疗在cT2N0期可切除食管癌患者中的临床意义。方法通过网上检索包括PubMed、Web of Science、EMBASE、the Cochrane Library、中国知网等一系列数据库,筛选符合本研究目的的真实世界研究,从中提取包括生存率、病理分期改变、切缘阳性、术后吻合口瘘等多种结局指标。通过RevMan 5.4与R version 4.0.2等数据分析软件对其进行荟萃分析。结果累计筛选出7项研究,共4602例cT2N0食管癌患者纳入分析,荟萃分析表明新辅助联合手术治疗组(NS)与单纯手术组(S)在5年生存率、无复发生存率、术后吻合口瘘发生率与病理升期方面差异均无统计学意义(P>0.05);然而两组在术中切缘阳性以及病理降期上差异均有统计学意义(P<0.05)。结论新辅助治疗联合手术较单纯手术并未给cT2N0食管癌患者带来明显生存获益及更高的吻合口瘘风险,也未降低病理升期风险,但应用新辅助治疗可有效降低病理分期以及术中切缘阳性的概率。推荐对于检查完善且胃镜病理提示不含高危因素的cT2N0食管癌患者可直接行手术治疗。
