化疗联合放疗三模态治疗或挽救性切除术与Ⅱ-Ⅲ期食管鳞状细胞癌的生存率

Esophageal squamous cell carcinoma (ESCC) remains highly lethal and often under-treated. With conflicting evidence regarding the additional benefit of surgical resection to chemoradiation, many patients with locoregionally-advanced disease may receive chemoradiation and then undergo evaluation for progression before esophagectomy. We hypothesized that trimodality therapy or salvage resection would be linked with superior overall survival, relative to definitive chemoradiation.

食管鳞状细胞癌（ESCC）仍然具有高度致命性，并且常常治疗不足。由于关于在化疗联合放疗（CRT）基础上追加手术切除是否带来额外获益的证据存在争议，许多局部晚期患者在接受CRT后会接受疾病进展评估，再决定是否行食管切除术。我们假设，与根治性CRT相比，三模态治疗或挽救性切除术可能与更长的总体生存期相关。

This retrospective analysis of the 2004-2021 National Cancer Database identified all clinically staged II-III ESCC patients≥18years. Patients undergoing chemotherapy and ≥41.4 Grays of radiation across 28 fractions, followed by esophagectomy <90 days were considered the trimodality cohort, while those undergoing resection ≥90 days were classified as salvage. Patients receiving definitive chemoradiation were categorized as definitive CRT.

本研究回顾性分析了2004-2021年美国国家癌症数据库（NCDB）中的数据，筛选出所有临床分期为Ⅱ-Ⅲ期且年龄≥18岁的ESCC患者。接受化疗并接受≥41.4 Gy放疗（共28次分割）后≤90天内接受食管切除术的患者归入三模态治疗组，≥90天后接受切除术的患者归入挽救性切除组，仅接受根治性CRT的患者归为根治性CRT组。

Of 3,786 patients, 912 (24%) underwent trimodality therapy, 173 (5%) chemoradiation followed by salvage resection, and 2,701 (71%) definitive CRT. Following risk-adjustment and relative to definitive CRT, trimodality was linked with greater survival at 1 (HR 0.45, CI 0.34-0.59) and 5 years (HR 0.57, CI 0.49-0.66), as was salvage (1 year: HR 0.38, CI 0.22-0.69; 5 year: HR 0.54, CI 0.40-0.73). Upon RMST analysis, trimodality demonstrated a 9.17 month (CI 6.40-11.94) incremental increase in overall survival time over 5 years, while salvage was linked with a 10.03 month (CI 4.04-16.03) increase in survival time, compared to definitive CRT.

在3,786例患者中，912例（24%）接受三模态治疗，173例（5%）接受CRT后行挽救性切除，2,701例（71%）接受根治性CRT。经过风险调整后，与根治性CRT相比：三模态治疗患者1年生存率（HR 0.45，95% CI 0.34-0.59）和5年生存率（HR 0.57，95% CI 0.49-0.66）均更高。挽救性切除同样在1年生存率（HR 0.38，95% CI 0.22-0.69）和5年生存率（HR 0.54，95% CI 0.40-0.73）方面优于根治性CRT。在限制平均生存时间（RMST）分析中，三模态治疗在5年内额外延长9.17个月（95% CI 6.40-11.94）的生存时间，而挽救性切除额外延长10.03个月（95% CI 4.04-16.03），相较于根治性CRT均表现出显著的生存获益。