对患有食道状细胞癌的患者进行新辅助化疗或新辅助化疗或新辅助放射治疗:来自日本全国性研究的现实数据比较
Akihiko Okamura1, Masayuki Watanabe2,3, Jun Okui4,5
1Department of Esophageal Surgery, Gastroenterology Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
Annals of surgical oncology
|June 1, 2023
概括
对食道状细胞癌 (ESCC) 的新辅助化疗 (NACRT) 显示出比新辅助化疗 (NAC) 更好的病理反应,但没有改善整体存活率. 在接受NACRT的早期 (cT1-2) 患者中观察到生存益处.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 胃肠病学 胃肠病学
背景情况:
- 新辅助治疗是局部晚期食道癌的标准治疗方法.
- 以前对新辅助化学疗法 (NAC) 和新辅助化学放射疗法 (NACRT) 的比较得出了不确定的结果.
研究的目的:
- 为了比较NAC与NACRT的疗效和生存结果,然后在患有食道状细胞癌 (ESCC) 的患者中进行手术.
主要方法:
- 一项对来自85所机构的3978名ESCC患者进行的回顾性研究,这些患者接受了NAC或NACRT,随后进行了手术.
- 治疗权重的逆概率 (IPTW) 用于比较分析.
主要成果:
- 与NAC相比,NACRT表现出较高的病理降级和响应率 (p < 0.001).
- 总体生存率 (OS),无复发生存率 (RFS) 和区域复发特异性生存率 (RRSS) 在整个组之间是可比的.
- 在早期 (cT1-2) 患者中,NACRT与NAC相比显著改善了5年后的OS,RFS和RRSS (P = 0.024,<0.001,0.020).
- 在晚期 (cT3-4a) 患者中没有发现显著的生存差异.
- 一个竞争的风险模型表明,NAC和NACRT之间的癌症和非癌症死亡率在10年内是可比的.
结论:
- 与NAC相比,ESCC的NACRT提供了增强的治疗效果,包括更好的病理反应.
- 尽管改善了病理结果,但NACRT并没有显著改善整体队列的整体存活率.
- NACRT并没有增加非癌症死亡的风险.
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