基于稳健逆概率处理加权法的局部晚期食管鳞癌不同新辅助治疗模式的生存分析  

Survival analysis of different neoadjuvant treatment modes in locally advanced esophageal squamous cell carcinoma based on the stabilized inverse probability of treatment weighting method

作　　者：李娇 于诺 冯国杰 郑子钰 梁军 邓垒 张涛 王文卿 刘文扬 王建仰 冯勤付 吕纪马 周宗玫 肖泽芬 毕楠 王镇 陈先凯 康晓征 张瑞祥 郑庆锋 秦建军 李勇 李印 王鑫 LI Jiao;YU Nuo;FENG Guojie;ZHENG Ziyu;LIANG Jun;DENG Lei;ZHANG Tao;WANG Wenqing;LIU Wenyang;WANG Jianyang;FENG Qinfu;LYU Jima;ZHOU Zongmei;XIAO Zefen;BI Nan;WANG Zhen;CHEN Xiankai;KANG Xiaozheng;ZHANG Ruixiang;ZHENG Qingfeng;QIN Jianjun;LI Yong;LI Yin;WANG Xin(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;Cancer Hospital,Chinese Academy of Medical Sciences,Shenzhen Hospital,Guangdong Shenzhen 518172,China;Department of Thoracic Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,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/中国医学科学院北京协和医学院肿瘤医院深圳医院放疗科,广东深圳518172 [3]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胸外科,北京100021

出　　处：《现代肿瘤医学》2024年第23期4449-4458,共10页Journal of Modern Oncology

基　　金：北京市希思科临床肿瘤学研究基金(编号:Y-Young2023-0114)。

摘　　要：目的:比较新辅助放化疗(neoadjuvant chemoradiotherapy,nCRT)和新辅助化疗(neoadjuvant chemotherapy,nCT)联合手术对局部晚期食管鳞癌患者的总生存率(overall survival,OS)、无病生存率(disease-free survival,DFS)以及影响预后相关因素的差异。方法:回顾性收集2012年~2020年在我院确诊并行新辅助治疗的食管鳞癌患者416例,其中,nCRT组158例,nCT组258例。采用稳健逆概率处理加权的方法(stabilized inverse probability of treatment weighting,sIPTW)将各协变量在两组中进行加权,校正混杂因素,采用Kaplan-Meier法计算OS、DFS,并用logrank法检验,Cox回归模型进行单因素、多因素预后分析。结果:nCRT组的中位随访时间为56(7~145)个月,nCT组的中位随访时间均为51(6~118)个月。全组416例患者中有69例(16.6%)的患者达pCR,其中nCRT组的pCR率明显优于nCT组(28.5%vs 9.3%,P<0.001)。在总生存方面,两组均未达到中位OS。sIPTW前,两组OS(P=0.770)和DFS(P=0.847)无显著差异;sIPTW后,nCRT组相比nCT组的OS(3年,5年OS分别为80.1%vs 77.0%、72.1%vs 66.3%,P=0.281)和DFS(3年,5年的DFS分别为70.2%vs 64.5%、61.0%vs 55.2%,P=0.315)倾向于更优,但均未达到统计学差异。多因素分析显示pT分期(P=0.005)、pN分期(P=0.007)是影响食管癌预后的独立因素。达pCR患者的OS(P<0.001)与DFS(P<0.001)均较未达pCR患者显著提高。结论:nCRT较nCT显著提高食管鳞癌的pCR率,且达pCR的患者生存预后更佳。sIPTW后,随着随访时间的延长,nCRT组的OS和DFS倾向优于nCT组,但均未达到统计学差异。Objective:To compare the effects of neoadjuvant radiotherapy(nCRT)and neoadjuvant chemotherapy(nCT)on overall survival(OS)and disease-free survival(DFS)in patients with locally advanced esophageal squamous carcinoma.Methods:A total of 416 patients with esophageal squamous cell carcinoma who underwent neoadjuvant therapy in our hospital from 2012 to 2020,including 258 patients in the nCT group and 158 patients in the nCRT group.The covariates were weighted in the nCRT and nCT groups using a stabilized inverse probability treatment weighting method(sIPTW)to corrected for confounders.The OS and DFS were calculated by K-M method,compared by logrank test,and multivariate analysis were performed by Cox regression model.Results:The median follow-up time was 56(7~145)months in the nCRT and 51(6~118)months in the nCT group.69 of the 416 patients(16.6%)achieved pCR in the whole group,with a significantly higher pCR rate(28.5%vs 9.3%,P<0.001)in the nCRT group than in the nCT group.Median survival was not reached in both the nCRT and nCT groups.Before sIPTW,there was no significant difference in overall survival(P=0.770)and disease-free survival(P=0.845)between the two groups.After sIPTW,nCRT promoted slightly more favorable survival,despite without statistical significance in overall survival(the 3-and 5-years overall survival rates of the nCRT and nCT groups were 80.1%vs 77.0% and 72.1%vs 66.3%,P=0.281)and disease-free survival(the 3-and 5-years were 70.2%vs 64.5% and 61.0%vs 55.2%,P=0.315),respectively.pT(P=0.005)and pN(P=0.007)were independent factors affecting the prognosis of esophageal cancer.Patients who receive pCR had significantly higher OS(P<0.001)and DFS(P<0.001)compared to non-pCR patients.Conclusion:nCRT received higher pCR rate significantly compared with nCT,and patients who achieve pCR rate have an excellent survival prognosis.After sIPTW,a trend favored nCRT related to the significantly higher OS and DFS in the nCRT group was better than that in the nCT group,but no significant differences was reached.In t

关 键 词：食管鳞癌 新辅助放化疗 新辅助化疗 手术 预后 

分 类 号：R735.1[医药卫生—肿瘤]