在食道切除术后用于食道癌的辅助疗法:谁需要它? :多机构的全球观测研究
Siva Raja1, Thomas W Rice1, Min Lu2
1From the Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH.
概括
食道切除术后的辅助疗法为特定的食道癌类型提供了生存益处,特别是节点阳性状细胞癌. 然而,它对腺癌的有效性仅限于晚期和显著的结节参与.
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:
- 对于局部晚期食道癌的食道切除术后的辅助疗法尚未得到充分证实.
- 目前的实践指南表明潜在的好处,但缺乏强有力的证据.
研究的目的:
- 为了确定患者一级的风险调整后生存率,单独治疗食道切除术与辅助治疗的食道切除术相比.
- 提供基于癌症组织病理学和癌症阶段的细粒度估计.
主要方法:
- 分析了来自全球食道癌协作 (1970-2014) 的22123名患者.
- 包括腺癌和状细胞癌组织学.
- 利用随机森林来确定生存率和虚拟双胞胎分析来确定所有原因的死亡率.
主要成果:
- 对于腺癌,辅助疗法有利于pT4NanyM0和pTanyN3M0阶段 (4-8个月生存益处),但在pT1-3N0M0阶段显示生存率下降.
- 对于状细胞癌,辅助疗法在pT3-4N0M0 (4-21个月) 和pT2-4N1-3M0 (4-15个月) 阶段提供了生存益处.
结论:
- 辅助疗法对大多数结节阳性状细胞癌患者有益.
- 对于腺癌,辅助疗法只有在深层或结节阳性癌症中才有价值.
- 未来的指导方针应该根据食道癌的组织病理学和阶段区分辅助治疗建议.
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