食管胃腺癌围手术期化疗与术前放化疗的真实世界临床结果分析

Analysis of real-world clinical outcomes of perioperative chemotherapy compared to preoperative chemoradiotherapy in esophagogastric adenocarcinoma.

期刊: Cancer
PMID: 42603143
原文: PubMed ↗
发布日期: 2026-08-15

作者

Mosunmoluwa Oyenuga — Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Subir Goyal — Biostatistics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Lindsay M Hannan — Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Oluwadunni Emiloju — Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Gideon T Dosunmu — Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Ruoyu Miao — Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Olumide Gbolahan — Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Maria Russell — Department of Surgery, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Jolinta Lin — Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Jeffrey M Switchenko — Biostatistics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Olatunji B Alese — Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.

作者单位

Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Biostatistics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Department of Surgery, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.

摘要

中文

非转移性食管胃腺癌需要多模式治疗。然而，这些患者的真实世界治疗模式和结果有限。我们评估了国家癌症数据库中常见治疗组合的生存结果。共有4715名患者符合预定义的纳入和排除标准。创建了四组：第1组，术前化疗；第2组，围手术期化疗；第3组，术前化疗后放化疗；第4组，术前放化疗。使用Kaplan-Meier曲线评估总生存期。Cox比例风险回归估计了协变量与总生存期之间的风险比（HR）和95%置信区间。基于倾向评分的治疗加权逆概率用于说明治疗组之间基线特征的差异。中位年龄为63岁；75.9%为男性，82.9%为非西班牙裔白人；总体而言，47.5%为临床III期疾病，57.8%有区域淋巴结受累。中位随访时间为79.5个月。接受围手术期化疗的患者与接受术前放化疗的患者相比，中位总生存期有所改善（79.1 vs 74.6个月；p < .001）。在调整年龄、种族、Charlson-Deyo评分、机构类型、诊断年份、区域淋巴结存在、临床分期后，该关联仍具有统计学意义（HR = 0.78；95% CI，0.66-0.92；p = .003）。尽管食管胃腺癌使用了多种多模式治疗策略，但围手术期化疗与术前放化疗相比，与更好的总生存期相关。

English

Nonmetastatic esophagogastric adenocarcinoma require multimodal treatment for management. However, real-world treatment patterns and outcomes in these patients are limited. We evaluated the survival outcomes associated with the common treatment combinations in the National Cancer Database. A total of 4715 patients met the predefined inclusion and exclusion criteria. Four groups were created: group 1, preoperative chemotherapy; group 2, perioperative chemotherapy; group 3, preoperative chemotherapy followed by chemoradiation; and group 4, preoperative chemoradiotherapy. Kaplan-Meier curves were used to assess overall survival. Cox proportional hazard regression estimated hazard ratios (HR) and 95% CIs for associations between covariates and overall survival. Inverse probability of treatment weighting based on propensity scores were used to account for differences in baseline characteristics between treatment groups. The median age was 63 years; 75.9% were male and 82.9% were non-Hispanic White; overall, 47.5% had clinical stage III disease and 57.8% had regional lymph node involvement. Median follow-up was 79.5 months. Patients who received perioperative chemotherapy had improved median overall survival compared with patients who received preoperative chemoradiotherapy (79.1 vs 74.6 months; p < .001). After adjustment for age, race, Charlson-Deyo Score, facility type, year of diagnosis, presence of regional lymph nodes, clinical stage, the association remained statistically significant (HR = 0.78; 95% CI, 0.66-0.92; p = .003). Although several multimodality treatment strategies are used for esophagogastric adenocarcinoma, perioperative chemotherapy is associated with better overall survival compared to preoperative chemoradiotherapy.

分类与指标

研究类型: 临床研究
病种: 食管癌
JCR 分区: Q1
影响因子: 5.6
新锐分区: 2区