Application of radiochemotherapy conversion therapy in unresectable locally advanced esophageal cancer
10.3760/cma.j.cn115355-20230301-00110
- VernacularTitle:放化疗转化治疗在不可切除局部晚期食管癌中的应用
- Author:
Yunkui ZHANG
1
;
Rongsheng ZHANG
;
Wenze TIAN
Author Information
1. 山西省肿瘤医院 中国医学科学院肿瘤医院山西医院 山西医科大学附属肿瘤医院胸外科，太原 030013
- Keywords:
Esophageal neoplasms;
Drug therapy;
Radiotherapy;
Conversion surgery therapy
- From:
Cancer Research and Clinic
2023;35(10):745-749
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical application value of radiochemotherapy conversion therapy in unresectable locally advanced esophageal cancer.Methods:A total of 298 patients with unresectable locally advanced esophageal cancer who received radiochemotherapy with or without surgery from 2010 to 2016 were screened in the U.S. Surveillance, Epidemiology, and End Results (SEER) 18 oncology database, and the patients were divided into the conversion therapy group (received surgery after radiotherapy, 83 cases) and the radiochemotherapy group (215 cases) according to whether they were operated after radiotherapy. A 1∶1 propensity matching analysis was conducted on the two groups of patients using R language. The information of age, gender, race, T stage, G stage, pathological type and N stage of the patients in the two groups before and after matching was compared. The Kaplan-Meier method was used for survival analysis to compare the cancer specific survival and overall survival (OS) between the two groups before and after matching. A multivariate Cox proportional hazards model was used to analyze the influencing factors of prognosis of patients with unresectable locally advanced esophageal cancer.Results:There were statistically significant differences in gender, race, G stage, pathological type, T stage, and N stage between the conversion therapy group and the radiochemotherapy group before matching (all P < 0.05). There was no statistically significant difference in clinicopathological characteristics between the conversion therapy group and the radiochemotherapy group after matching (all P > 0.05). Before matching, the median OS time of patients in the conversion therapy group was 23 months; the 1-year, 2-year, 3-year, and 5-year OS rates were 68.9%, 42.9%, 24.7%, and 19.8%, respectively; the 1-year, 2-year, 3-year, and 5-year cancer specific survival rates were 68.9%, 45.0%, 28.0%, and 28.0%, respectively. The median OS time of patients in the radiochemotherapy group was 12 months; the 1-year, 2-year, 3-year and 5-year OS rates were 44.5%, 20.5%, 14.0%, and 6.0%, respectively; the 1-year, 2-year, 3-year and 5-year cancer specific survival rates were 46.4%, 21.8%, 14.9%, and 9.1%, respectively. Compared with the radiochemotherapy group, patients in the conversion therapy group had a better cancer specific survival ( χ2 = 15.01, P = 0.001) and OS ( χ2 = 14.85, P < 0.001). After matching, cancer specific survival ( χ2 = 5.06, P = 0.024) and OS ( χ2 = 6.12, P = 0.013) of the conversion therapy group were still superior to the radiochemotherapy group. The results of multivariate Cox regression analysis showed that the cancer specific survival risk and overall survival risk in the radiochemotherapy group were 1.874 times (95% CI 1.275-2.755, P = 0.001) and 1.790 times (95% CI 1.235-2.593, P = 0.002) higher than those in the conversion therapy group. Conclusions:Radiochemotherapy conversion therapy can improve the prognosis of patients with unresectable locally advanced esophageal cancer.
