新辅助疗法后的时间预测了接受食道切除术的患者的死亡率:一种倾向性得分匹配分析
Taylor Maramara1, Ravi Shridhar2, Paige Blinn1
1College of Medicine, Florida State University, 1950 Arlington Street, Suite 101, Sarasota, FL, USA.
概括
为食道癌延长新辅助疗法和食道切除术之间的时间增加了90天的死亡率,但没有改善生存率. 为了获得最佳的患者结果,应保持目前的6-12周时间建议.
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:
- 目前的指导方针建议在新辅助疗法和食道癌食道切除术之间6-12周.
- 有些人提倡更长的间隔,以潜在地增加完整的病理反应,与改善的生存率相关联.
- 延长的新辅助疗法-手术时间对结果的影响还不太清楚.
研究的目的:
- 评估新辅助疗法和食道切除术之间的不同时间间隔对患者结局的影响.
- 为了确定延长间隔是否改善食道癌患者的生存率或病理完整反应率.
- 评估新辅助疗法-手术时间对90天死亡率的影响.
主要方法:
- 利用国家癌症数据库识别食道癌患者,这些患者接受了新辅助疗法,随后进行了食道切除术.
- 将患者分类为三个时间间隔:<6周,6-12周和>3个月.
- 在时间间隔内分析了淋巴结收获,阳性淋巴结,完整反应率,中位生存率和90天死亡率的差异数据.
主要成果:
- 总共有9256名患者被分析;84.9%是男性,平均年龄为62.
- 较长的间隔显示,收获的中枢淋巴结数量减少,中枢淋巴结数量减少.
- 随着时间间隔的延长 (p<0.001),完整病理反应率增加,但这并没有转化为改善中位生存率. 90天死亡率随着时间间隔的延长而显著增加 (p=0.002).
结论:
- 延长新辅助疗法和食道切除术之间的间隔导致90天死亡率显著增加.
- 尽管完全响应率更高,但延长时间并不能改善食道癌患者的生存率.
- 既定的6-12周的新辅助疗法-手术间隔应该仍然是标准的护理.
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