颈段食管癌放化疗对比手术疗效:基于人群竞争风险分析  

Efficacy of chemoradiotherapy versus surgery in cervical esophageal cancer: a population-based competing risk analysis

作　　者：纪光前 张笑笑 马正慧 凡新苓 亓姝楠 易俊林[1,2] 张涛 Ji Guangqian;Zhang Xiaoxiao;Ma Zhenghui;Fan Xinling;Qi Shunan;Yi Junlin;Zhang Tao(Department of Radiation Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Radiation Oncology,National Cancer Center/National Clinical Research Center for Cancer/Hebei Cancer Hospital,Chinese Academy of Medical Sciences,Langfang 065001,China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院放疗科,北京100021 [2]国家癌症中心/国家肿瘤临床医学研究中心/河北中国医学科学院肿瘤医院放疗科,廊坊065001

出　　处：《中华放射肿瘤学杂志》2023年第6期506-511,共6页Chinese Journal of Radiation Oncology

摘　　要：目的评估放化疗和手术在颈段食管癌(CEC)治疗中的价值。方法回顾性分析美国国立癌症研究所监测、流行病学和最终结果(SEER)数据库, 收集2004—2017年的颈段食管癌患者资料, 共459例纳入研究。根据治疗因素将患者分为放化疗组(379例)及手术组(80例)。采用Kaplan-Meier法对入组病例进行生存分析并绘制生存曲线, 运用Cox比例风险回归模型进行多因素生存分析, 采用累积发生函数(CIF)估算两组不同原因死亡率, 用Fine-Gray竞争风险模型评价两组间死亡率差异。通过分析CEC患者临床特征和生存情况, 比较手术和放化疗的总生存(OS)有无差异。结果放化疗组2、5年生存率分别为43.1%、22.4%, 手术组2、5年生存率分别为46.8%、26.0%。放化疗组和手术组比较, OS无明显差异(P=0.750)。Cox多因素分析结果显示, 治疗方式(手术∶放化疗)不是OS的独立影响因素。基于竞争风险分析结果, 放化疗组患者的食管癌特异性死亡风险高于手术组, 两组间差异有统计学意义(P<0.001), 放化疗组患者的其他原因特异性死亡风险低于手术组(P<0.001)。手术组死于口腔、口咽、下咽及喉部疾病的比例明显高于放化疗组(P<0.001)。结论 CEC患者行放化疗或手术治疗OS无明显差异。手术组食管癌特异性死亡风险低, 但其他原因死亡风险高。Objective To evaluate the value of chemoradiotherapy and surgery in cervical esophageal cancer(CEC).Methods Data of 459 patients with CEC from 2004 to 2017 were collected and retrospectively analyzed from the surveillance,epidemiology,and end results(SEER)database of National Cancer Institute(US).All patients were divided into the chemoradiotherapy group(n=379)and surgery group(n=80)according to the treatment methods.Survival analysis was performed by Kaplan-Meier method and survival curve was drawn.Multivariate survival analysis was conducted by Cox proportional hazards regression model.The death rate of different causes between two groups was calculated by cumulative incidence function(CIF).The differences of death rate between two groups were evaluated by Fine-Gray competing risk model.By analyzing the clinical characteristics and survival of CEC patients,the overall survival(OS)was compared between the surgery and chemoradiotherapy groups.Results The 2-and 5-year survival rates in the chemoradiotherapy group were 43.1%and 22.4%,while those of the surgical group were 46.8%and 26.0%,respectively.No significant difference was observed in the OS between the chemoradiotherapy and surgery groups(P=0.750).Cox multivariate analysis showed that treatment(surgery group vs.chemoradiotherapy group)was not an independent prognostic factor for OS.Based on the results of competing risk analysis,the risk of esophageal cancer-specific death in the chemoradiotherapy group was higher than that in the surgery group,and the difference was statistically significant between two groups(P<0.001).The risk of other cause-specific death in the chemoradiotherapy group was lower than that in the surgery group(P<0.001).The proportion of patients who died of oral,oropharyngeal,hypopharyngeal and laryngeal diseases in the surgery group was significantly higher than that in the chemoradiotherapy group(all P<0.001).Conclusions No significant difference is observed in the OS of CEC patients treated with chemoradiotherapy or surgery.In the surge

关 键 词：食管肿瘤 颈段 放化疗 手术 预后 监测、流行病学和最终结果数据库 

分 类 号：R735.1[医药卫生—肿瘤]