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在第二到第三阶段食道癌的生存和治疗模式
Won Jin Jeon1, Daniel Park2, Farris Al-Manaseer3
1Division of Medical Oncology and Hematology, Department of Internal Medicine, Loma Linda University, Loma Linda, California.
JAMA network open
|October 21, 2024
概括
对于局部发达的食道癌 (EC),三种疗法比单独的终极化疗 (DCRT) 或放射治疗 (RT) 改善了存活率. 周围手术化疗也显示了食道腺癌 (EAC) 的生存率有所改善.
科学领域:
- 在瘤学瘤学.
- 临床研究 临床研究
- 流行病学 流行病学
背景情况:
- 临床试验表明,新辅助化学辐射疗法 (NCRT) 随后对局部晚期食道癌 (EC) 进行手术,对食道腺癌 (EAC) 进行外科化疗.
- 需要现实世界的数据来确认这些发现是否会在临床实践中转化为更好的生存率.
研究的目的:
- 在现实环境中评估和比较II-III期EC患者的整体生存 (OS) 结果,这些患者接受了不同的治疗方式.
- 为了研究三种疗法,最终化疗辐射疗法 (DCRT),单独放射疗法 (RT) 和术后化疗疗法的有效性.
主要方法:
- 使用国家癌症数据库 (2006-2020) 的57,116名II-III期EC患者 (不包括胃食道结癌) 的回顾性队列研究.
- 治疗组包括三种疗法,DCRT,单种疗法RT和外科化疗.
- 为了减轻生存偏差,在6个月后使用考克斯比例危险回归和里程碑分析来比较总生存率 (OS).
主要成果:
- 与DCRT相比,外科化疗 (AHR,0.33) 和三模式疗法 (AHR,0.45) 与显著改善的生存状况有关.
- 与DCRT相比,单模RT与更差的结果相关 (AHR,1.37).
- 术后化疗 (66.2个月) 的中位数是最长的,其次是三模式治疗 (43.9个月),DCRT (18.1个月) 和单独RT (13.5个月).
- 在65岁以上的患者中,外科化疗也显示了最长的中位数生存期 (56.7个月).
结论:
- 与单独使用DCRT或RT相比,三模式治疗与局部晚期食道癌的存活率提高有关.
- 在现实环境中,外科化疗表明食道腺癌的生存结果优越.
- 这些发现强调了基于癌症类型和癌症阶段的治疗选择对于优化患者生存的重要性.
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