食管或食管胃交界部腺癌的根治性放化疗：一项荷兰基于人群的队列研究
Definitive Chemoradiotherapy for Adenocarcinoma of the Esophagus or Esophago-Gastric Junction: A Dutch Population-Based Cohort Study.
作者
作者单位
- Department of Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands. s.gangaram-panday@erasmusmc.nl.
- Department of Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands.
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands.
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands.
- Department of Radiation Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands.
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands.
摘要
中文
局部晚期食管腺癌预后差，当无法或不愿手术时治疗选择有限。尽管根治性放化疗（dCRT）目前作为一种根治性治疗手段应用，但关于其对食管腺癌患者疗效的数据有限，需要进一步评估生存结局。从荷兰全国癌症登记处（2015-2022年）中识别诊断为食管或食管胃交界部腺癌并接受dCRT（定义为放射剂量> 41.4 Gy且≤ 50.4 Gy）的患者。分析总生存期（OS），并进行多变量Cox回归分析以评估预后因素。对2015-2017年有详细随访数据的亚组患者估计无进展生存期（PFS）。研究分析了926例患者，其中263例有复发模式数据。其中，77%的患者诊断为III/IVa期疾病，72%的患者WHO体能状态为0-1。90天死亡率为7.1%。中位OS为19.6个月（95%置信区间[CI]，18.6-21.2个月），3年OS为28%。中位PFS为12.1个月（95% CI，9.7-14.0个月）。临床T3-T4分期、cN+分期、WHO体能状态和肿瘤长度与较差的生存相关，尽管多变量模型的区分能力有限。接受dCRT的食管或食管胃交界部腺癌患者的真实世界OS和PFS较差，90天死亡率较高。这些结果强调需要优化患者选择、充分知情的共同决策以及开发改进的治疗策略。
English
Locally advanced esophageal adenocarcinoma has a poor prognosis and limited treatment options when surgery is not possible or desired. Although definitive chemoradiotherapy (dCRT) is currently administered as a curatively intended treatment, limited data exist regarding its efficacy for patients with adenocarcinoma of the esophagus, necessitating further evaluation of survival outcomes. Patients with a diagnosis of adenocarcinoma of the esophagus or esophago-gastric junction who had undergone dCRT (defined as a radiation dose of > 41.4 Gy and ≤ 50.4 Gy, respectively) were identified from the nationwide Netherlands Cancer Registry (2015-2022). Overall survival (OS) was analyzed, and multivariable Cox regression analysis was performed to evaluate prognostic factors. Progression-free survival (PFS) was estimated for the subgroup of patients with detailed follow-up data from 2015 to 2017. The study analyzed 926 patients, including 263 patients with data on recurrence patterns. Of these patients, 77% had a diagnosis of stage III/IVa disease, and 72% had a WHO performance status of 0 to 1. The 90-day mortality rate was 7.1%. The median OS was 19.6 months (95% confidence interval [CI], 18.6-21.2 months), and the 3-year OS was 28%. The median PFS was 12.1 months (95% CI, 9.7-14.0 months). Clinical T3-T4 category, cN+ category, WHO performance status, and tumor length were linked to worse survival, although the multivariable model had limited discriminatory power. Real-world OS and PFS for patients with adenocarcinoma of the esophagus or esophago-gastric junction who received dCRT were poor, and 90-day mortality was substantial. These outcomes highlight the need for optimal patient selection, well-informed shared decision-making, and the development of improved treatment strategies.
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
- 3.8
- 新锐分区
- 2区