基于倾向性评分匹配的食管胃结合部腺癌不同综合治疗模式的单中心回顾性研究  

The impact of different comprehensive treatment models on patients with adenocarcinoma of esophagogastric junction based on propensity score matching:a single center cohort study

作　　者：戴红梅 王胤奎[1] 应项吉 李双喜[1] 陕飞[1] 贾永宁[1] 薛侃[1] 苗儒林[1] 李浙民 李子禹[1] 季加孚[1] Dai Hongmei;Wang Yinkui;Ying Xiangji;Li Shuangxi;Shan Fei;Jia Yongning;Xue Kan;Miao Rulin;Li Zhemin;Li Ziyu;Ji Jiafu(Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education),Gastrointestinal Cancer Center,Peking University Cancer Hospital&Institute,Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院,暨北京市肿瘤防治研究所胃肠肿瘤中心,恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《中华外科杂志》2022年第9期846-852,共7页Chinese Journal of Surgery

基　　金：国家自然科学基金(31870805);北京市医院管理局“登峰”人才计划(DFL20181103);北京市科技计划(D171100006517004)。

摘　　要：目的比较不同综合治疗模式对食管胃结合部腺癌患者术后病理学分期及远期生存的影响。方法回顾性分析2012年1月1日至2017年12月31日北京大学肿瘤医院胃肠肿瘤中心收治的219例食管胃结合部腺癌手术患者的临床和病理学资料,根据围手术期综合治疗模式分为直接手术组、新辅助化疗组和新辅助放化疗组。使用R语言的“Trimatch”包,以性别、年龄、合并症、体重指数、临床T分期、临床N分期及Siewert分型为协变量对3组进行匹配,卡钳值取0.2;每组29例患者共87例纳入分析。男性82例,女性5例,中位年龄63岁(范围:38~76岁)。采用方差分析、Wilcoxon秩和检验或χ^(2)检验比较各组术后病理学分期,两两比较采用Mann-Whitney U检验或χ^(2)检验;采用Kaplan-Meier法绘制生存曲线,Log-rank检验进行组间比较。结果直接手术组脉管癌栓的比例为72.4%(21/29),高于新辅助化疗组的37.9%(11/29)(χ^(2)=6.971,P=0.008)和新辅助放化疗组的6.9%(2/29)(χ^(2)=26.696,P<0.01)。新辅助放化疗组和新辅助化疗组病理T3~4期的比例分别为55.2%(16/29)和62.1%(18/29),低于直接手术组的93.1%(27/29)(χ^(2)=10.881,P=0.001;χ^(2)=8.031,P=0.005)。直接手术组病理N(+)期比例为86.2%(25/29),高于新辅助化疗组的55.2%(16/29)(χ^(2)=6.740,P=0.009)和新辅助放化疗组的31.0%(9/29)(χ^(2)=18.196,P<0.01)。直接手术组、新辅助化疗组和新辅助放化疗组的5年总体生存率分别为62.1%、68.6%和41.4%(χ^(2)=4.976,P=0.083),5年无进展生存率分别为61.7%、65.1%和41.1%(χ^(2)=4.332,P=0.115)。结论新辅助化疗和新辅助放化疗可降低食管胃结合部腺癌患者T3~4期、N+期和脉管癌栓比例,达到肿瘤局部控制。三种治疗模式的预后无明显差别。Objective To compare the prognostic influence and postoperative pathology of different comprehensive treatment models for adenocarcinoma of esophagogastric junction.Methods Between January 2012 and December 2017,a total of 219 patients with adenocarcinoma of esophagogastric junction underwent surgery in Gastrointestinal Cancer Center,Peking University Cancer Hospital&Institute and were enrolled in this study.The clinicopathological data of these patients were collected.The patients were categorized into 3 groups according to different treatment models:surgery-first group,neoadjuvant chemotherapy(NAC)group and neoadjuvant chemoradiotherapy(nCRT)group.A trimatch propensity score analysis was applied to control potential confounders among the three groups by using R language software.A total of 7 covariates including gender,age,comorbidity,body mass index,clinical T stage,clinical N stage and Siewert type were included,and the caliper value was taken as 0.2.After matching,a total of 87 patients were included for analysis with 27 patients for each group.There were 82 males and 5 females,with a median age of 63 years(range:38 to 76 years).The effect of preoperative treatment on postoperative tumor pathology among the three different comprehensive treatment models was explored byχ^(2) test,ANOVA or Wilcoxon rank sum test.Mann-Whitney U test orχ^(2) test were used to undergo pairwise comparisons.Kaplan-Meier method and Log-rank test were used to analyze the overall survival and progression-free survival.Results The proportion of vascular embolism in the surgery-first group was 72.4%(21/29),which was significantly higher than NAC group(37.9%(11/29),χ^(2)=6.971,P=0.008)and nCRT group(6.9%(2/29),χ^(2)=26.696,P<0.01).The proportions of pathological T3-4 stage in nCRT group and NAC group were 55.2%(16/29)and 62.1%(18/29),respectively,which were significantly lower than the surgery-first group(93.1%(27/29),χ^(2)=10.881,P=0.001;χ^(2)=8.031,P=0.005).Compared with the NAC group(55.2%(16/29),χ^(2)=6.740,P=0.009)and nCRT gr

关 键 词：食管胃接合处 腺癌 胃肿瘤 新辅助化疗 新辅助放化疗 外科手术 预后 

分 类 号：R735[医药卫生—肿瘤]