T1~3N0M0期食管腺癌围手术期放疗的生存获益：一项基于SEER数据库的回归性研究

Survival Benefit of Perioperative Radiotherapy for T1~3N0M0 Esophageal Adenocarcinoma: A Retrospective Study Based on the SEER Database

摘要: 背景：围手术期放疗对淋巴结阴性食管腺癌患者的预后是存在争议的。本研究旨在探讨分期为T1~3N0M0的可切除食管腺癌患者接受围手术期放疗的预后情况。方法：从SEER数据库中检索诊断为原发性食管腺癌患者的临床资料和生存数据。采用1:1倾向性评分匹配法消除基线特征差异。采用多因素Cox回归分析和Log-rank法评价手术前后接受辅助放疗和单独手术患者的生存差异，利用Kaplan-Meier绘制生存曲线图。结果：在2672例食管癌患者(T1~3N0M0)中，有985例患者行手术 + 围手术期放疗，1687例患者行单纯手术切除。倾向性匹配前，单纯手术组的5年生存率为64.2%优于手术 + 放疗组的5年生存率44.9%；仅行手术患者的5年肿瘤特异性生存率也更好(71.8% vs 47.9%)。倾向性匹配后，单纯手术组的5年肿瘤特异性生存率(58.5%)优于手术 + 放疗组5年肿瘤特异性生存率(45.3%)。多因素COX回归显示，倾向性匹配前，手术 + 放疗组的总生存期(Overall Survival, OS) (HR = 1.40; 95% CI: 1.16~1.69; P = 0.003)和肿瘤特异性生存期(Cancer Specific Survival, CSS) (HR = 1.48; 95% CI: 1.17~1.86; P = 0.005)更差。生存分析显示，手术联合围手术期放疗对T1~3期食管腺癌患者没有生存获益。分期为T1的患者，单纯手术组的生存率高于手术 + 围手术期放疗组。与单纯手术相比，接受手术 + 放疗的T2~3患者生存率无显著提高。结论：分期为T1~3N0MO的食管腺癌患者行围手术期放疗价值有限，围手术期放疗不能为T2~3期食管腺癌患者带来更多生存益处，可能是T1期患者的不良预后因素。

Abstract: Background: The prognosis of patients with node-negative esophageal adenocarcinoma with perioperative radiotherapy is controversial. The objective of this study was to investigate the prognosis of patients with esophageal adenocarcinoma staging T1~3N0M0 who received perioperative radiotherapy. Methods: The clinical data and survival data of patients diagnosed with primary esophageal adenocarcinoma were retrieved from SEER database. A 1:1 propensity score matching method was used to eliminate baseline feature differences. Multivariate Cox regression analysis and Log-rank method were used to evaluate the survival difference between patients who received adjuvant radiotherapy before and after surgery and those who underwent surgery alone. Kaplan-Meier was used to draw the survival curve. Results: Among 2672 patients with esophageal cancer (T1~3N0M0), 985 underwent surgery + perioperative radiotherapy and 1687 underwent surgical resection alone. Before orientation matching, the 5-year survival rate of operation group was 64.2%, which was better than that of operation + radiotherapy group (44.9%). Patients who underwent surgery alone also had better 5-year tumor-specific survival (71.8% vs 47.9%). After orientation matching, the 5-year tumor specific survival rate (58.5%) in the surgery group was better than that in the surgery + radiotherapy group (45.3%). Multivariate COX regression showed that overall survival (OS) in the surgery + radiotherapy group before propensity matching (HR = 1.40; 95% CI, 1.16~1.69; P = 0.003) and cancer specific survival (CSS) (HR = 1.48; 95% CI, 1.17~1.86; P = 0.005) is worse. Survival analysis showed that surgery combined with perioperative radiotherapy had no survival benefit for patients with stage T1~3 esophageal adenocarcinoma. The survival rate of patients with T1 stage was higher in the operation group than in the operation + perioperative radiotherapy group. There was no significant improvement in survival in T2~3 patients who received surgery plus radiotherapy compared with surgery alone. Conclusion: Perioperative radiotherapy is of limited value for patients with esophageal adenocarcinoma with stage T1~3N0M0. Perioperative radiotherapy cannot bring more survival benefits for patients with esophageal adenocarcinoma with stage T2~3, which may be a poor prognostic factor for patients with stage T1.