新辅助化学辐射治疗后的阶段变化与食道癌患者的存活率有关
Muhammad M Qureshi1,2, Yue Lin1, Alexander R Moeller1
1Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.
新辅助化学辐射 (CRT) 显著影响食道癌存活率. 在CRT后达到病理完整反应 (pCR) 提供了最佳的生存结果,而升级阶段表明预后较差.
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:
- 食道癌症的治疗往往涉及手术前的新辅助化学辐射 (CRT).
- 通过阶段变化评估治疗反应对于预测患者的结果至关重要.
- 了解后新辅助CRT阶段改变的影响对于食道癌症管理至关重要.
研究的目的:
- 调查新辅助化疗 (CRT) 后癌症阶段变化与食道癌患者的存活率之间的关联.
- 分析基于病理完整反应 (pCR),下降阶段,没有变化或上升阶段的生存差异后新辅助CRT.
- 利用国家数据库对食道癌治疗反应和存活率进行全面分析.
主要方法:
- 利用国家癌症数据库识别患有非转移性,可切除食道癌的患者,这些患者接受了新辅助CRT和手术.
- 通过比较临床和病理阶段,对瘤阶段的变化进行分类,将结果分类为pCR,下阶段,同阶段或上阶段.
- 采用单变量和多变量考克斯回归模型来确定与整体存活 (OS) 相关的因素.
主要成果:
- 总共分析了7745名患者,平均整体存活期 (OS) 为34.9个月.
- 病理完整反应 (pCR) 产生了最高的中位数OS (60.3个月),其次是下阶段 (39.1个月),同阶段 (28.3个月) 和上阶段 (23.4个月) 的瘤 (p < 0.0001).
- 多变量分析证实,与其他阶段变化相比,pCR显著改善了OS (例如,升级阶段的HR与pCR相比:2.54,p < 0.0001).
结论:
- 新辅助CRT后的阶段改变是食道癌患者生存的重要预测因素.
- 观察到明显的生存率逐步下降,pCR与最佳结果相关,而最差的结果则升级.
- 这些发现强调了评估后新辅助CRT阶段在切除食道癌的治疗规划和预后的重要性.
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