II级至III食管癌的生存和治疗模式

现有的临床试验有利于新辅助化学疗法治疗（NCRT），然后仅进行局部晚期食管癌（EC）和围手术期化学疗法作为食管腺癌（EAC）的首选方式。但是，尚不清楚这些试验发现是否反映在临床环境中患者的护理和生存结果中。在各种治疗方式之后，研究EC患者的临床环境中的生存结果。回顾性同时研究研究了这项研究的数据研究了由美国外科医生和II级疾病的患者进行的全国癌症数据库中的数据，并专注于II II级的II II级，并将其专注于II II级，包括II II级，包括II II级，包括II级，包括II II级，该数据，包括II II级，包括II II级，该数据，该数据，包括II II级，包括II II级，该数据，该数据，包括II II级，并专注于II级的II级别，该数据，该数据，该数据，包括II II级的II级别，该数据库，并将其分析，该数据包括。 WHO接受三疗法治疗（NCRT，然后进行食管切除术），确定的化学放疗治疗（DCRT），放疗（RT）或2006年1月至2020年12月的围手术性化学疗法。分析是从2023年12月至2023年8月进行的。模型用于比较整个队列中的治疗组，鳞状细胞癌或腺癌患者以及65岁以上的患者中的总体生存期（OS）。进行了6个月的地标生存分析以减少BIA的生存。该研究包括57116例患者（中位年龄，64 [IQR，57-72]年； 45410 [79.5％]男性）； 21619例患者（37.9％）接受了三连疗疗法，32493（57.1％）接受了DCRT，2692（4.7％）接受了单模性RT，而312（0.5％）接受了围手术期的化学疗法。在整个研究人群中，有37698例患者（66.0％）患有EAC，在接受围手术期化疗的312例患者中，有283例（90.7％）患有EAC。在调整后的生存分析中，围手术期化学疗法（调整危险比[AHR]，0.33; 95％CI，0.28-0.39; p <.001）和三型疗法（AHR，0.45; 95％CI，0.44-0.46; p <.001）与与DCRT相比相关。相比之下，与DCRT相比，仅RT与较差的结果有关（AHR，1.37; 95％CI，1.30-1.45; P <.001）。与单独使用DCRT相比，围手术期化学疗法的中值OS为66.2个月（95％CI，43.1-111.9个月; P <.001）更长（18.1个月； 95％CI，17.8-18.4个月； P <.001）。培养治疗与中位OS为43.9个月（95％CI，42.8-45.5个月; P <.001），这比围手术性化疗的短距离要短，但与DCRT和RT相比，它比单独使用DCRT和RT，这与13.5个月的中位OS相关（95％CI，12.8-14.0个月; P <.001）。在65岁以上的患者亚组中，接受围手术期化疗的患者的中位数较长（56.7个月； 95％CI，36.4-115.2个月； P <.001），与接受其他治疗方式的患者相比（例如，三症治疗：40.1个月; 40.1; 95％CI，38.1-1-1-42.0;单独接受RT的患者的中位数最差（13.6个月； 95％CI，12.8-14.4个月； P <.001）。在这项对II期至III期EC患者的同类研究研究中，与局部先进的EC和外围化学疗法相关的DCRT或RT相比，Trimodality Therapy与RT与单独使用的DCRT或RT相比，与OSSAPIC相关联。

Existing clinical trials favor neoadjuvant chemoradiation therapy (NCRT) followed by surgery alone for locally advanced esophageal cancer (EC) and perioperative chemotherapy as the preferred modality for esophageal adenocarcinoma (EAC). However, it is unclear whether these trial findings are reflected in the patterns of care and survival outcomes among patients in the clinical setting.To investigate survival outcomes in the clinical setting among patients with EC after various treatment modalities.This retrospective cohort study examined data from the National Cancer Database maintained by the American College of Surgeons and focused on patients with clinical stage II or III EC, excluding those with gastroesophageal junction cancer, who underwent trimodality therapy (NCRT followed by esophagectomy), definitive chemoradiation therapy (DCRT), radiotherapy (RT) alone, or perioperative chemotherapy from January 2006 to December 2020. Analyses were conducted from December 2023 to August 2024.Perioperative chemotherapy, trimodality therapy, DCRT, and single-modality RT.A Cox proportional hazards regression model was used to compare overall survival (OS) between treatment groups in the entire cohort, among patients with squamous cell carcinoma or adenocarcinoma, and among those older than 65 years. Landmark survival analysis at 6 months was performed to reduce survivorship bias.The study included 57 116 patients (median age, 64 [IQR, 57-72] years; 45 410 [79.5%] male); 21 619 patients (37.9%) received trimodality therapy, 32 493 (57.1%) received DCRT, 2692 (4.7%) received single-modality RT, and 312 (0.5%) received perioperative chemotherapy. In the overall study population, 37 698 patients (66.0%) had EAC, and of the 312 patients that received perioperative chemotherapy, 283 (90.7%) had EAC. In adjusted survival analysis, perioperative chemotherapy (adjusted hazard ratio [AHR], 0.33; 95% CI, 0.28-0.39; P <.001) and trimodality therapy (AHR, 0.45; 95% CI, 0.44-0.46; P < .001) were associated with improved OS compared with DCRT. In contrast, RT alone was associated with worse outcomes compared with DCRT (AHR, 1.37; 95% CI, 1.30-1.45; P < .001). The median OS for perioperative chemotherapy of 66.2 months (95% CI, 43.1-111.9 months; P < .001) was longer compared with that for DCRT alone (18.1 months; 95% CI, 17.8-18.4 months; P < .001). Trimodality therapy was associated with a median OS of 43.9 months (95% CI, 42.8-45.5 months; P < .001), which was shorter than that for perioperative chemotherapy but improved compared with DCRT and RT alone, which was associated with a median OS of 13.5 months (95% CI, 12.8-14.0 months; P < .001). In the subgroup of patients older than 65 years, those who received perioperative chemotherapy had longer median OS (56.7 months; 95% CI, 36.4-115.2 months; P < .001) compared with those receiving other treatment modalities (eg, trimodality therapy: 40.1 months; 95% CI, 38.1-42.0 months; P < .001). Patients who received RT alone had the worst median OS (13.6 months; 95% CI, 12.8-14.4 months; P < .001).In this cohort study of patients with stage II to III EC, trimodality therapy was associated with improved OS compared with DCRT or RT alone for locally advanced EC and perioperative chemotherapy was associated with improved OS for adenocarcinoma.