背景:内镜黏膜下剥离术(ESD)和手术切除是cT1N0M0食管癌(EC)的护理标准,而确定性放化疗(d-CRT)是一种治疗选择。然而,ESD的相对效率和安全性,cT1N0M0EC的手术和d-CRT仍不清楚。
目的:为了比较ESD的效率和安全性,cT1N0M0EC的手术和d-CRT。
方法:回顾性分析2017-2019年在中山大学肿瘤防治中心连续治疗的472例cT1N0M0EC患者的住院资料,随访至10月30日。2022年。我们分析了人口统计,医疗记录,组织病理学特征,成像和内窥镜,和后续数据。采用Kaplan-Meier法和Cox比例风险模型分析各治疗组生存结局的差异。使用治疗权重的逆概率(IPTW)来最小化潜在的混杂因素。
结果:我们回顾性分析了2017年至2019年在中山大学肿瘤中心接受ESD(n=99)或手术(n=220)或d-CRT(n=16)的患者。ESD组的中位随访时间,手术组,d-CRT组为42.0个月(95CI:35.0-60.2),45.0个月(95CI:34.0-61.75)和32.5个月(95CI:28.3-40.0),分别。使用IPTW调整背景因素后,ESD组的3年总生存率(OS)和3年无复发生存率(RFS)最高(3年OS:99.7%和94.7%和79.1%;3年RFS:98.3%,87.4%和79.1%,在ESD中,外科,和d-CRT组,分别)。3组严重并发症发生率差异无统计学意义(P≥0.05)。多因素分析显示,治疗方法,组织学和浸润深度与OS和RFS独立相关。
结论:对于cT1N0M0EC,与接受d-CRT和手术的患者相比,ESD具有更好的长期生存率和更低的住院费用。严重并发症发生率相似。
BACKGROUND: Endoscopic submucosal dissection (ESD) and surgical resection are the standard of care for cT1N0M0 esophageal cancer (EC), whereas definitive chemoradiotherapy (d-CRT) is a treatment option. Nevertheless, the comparative efficiency and safety of ESD, surgery and d-CRT for cT1N0M0 EC remain unclear.
OBJECTIVE: To compare the efficiency and safety of ESD, surgery and d-CRT for cT1N0M0 EC.
METHODS: We retrospectively analyzed the hospitalized data of a total of 472 consecutive patients with cT1N0M0 EC treated at Sun Yat-sen University Cancer center between 2017-2019 and followed up until October 30th, 2022. We analyzed demographic, medical recorded, histopathologic characteristics, imaging and endoscopic, and follow-up data. The Kaplan-Meier method and Cox proportional hazards modeling were used to analyze the difference of survival outcome by treatments. Inverse probability of treatment weighting (IPTW) was used to minimize potential confounding factors.
RESULTS: We retrospectively analyzed patients who underwent ESD (n = 99) or surgery (n = 220) or d-CRT (n = 16) at the Sun Yat-sen University Cancer Center from 2017 to 2019. The median follow-up time for the ESD group, the surgery group, and the d-CRT group was 42.0 mo (95%CI: 35.0-60.2), 45.0 mo (95%CI: 34.0-61.75) and 32.5 mo (95%CI: 28.3-40.0), respectively. After adjusting for background factors using IPTW, the highest 3-year overall survival (OS) rate and 3-year recurrence-free survival (RFS) rate were observed in the ESD group (3-year OS: 99.7% and 94.7% and 79.1%; and 3-year RFS: 98.3%, 87.4% and 79.1%, in the ESD, surgical, and d-CRT groups, respectively). There was no difference of severe complications occurring between the three groups (P ≥ 0.05). Multivariate analysis showed that treatment method, histology and depth of infiltration were independently associated with OS and RFS.
CONCLUSIONS: For cT1N0M0 EC, ESD had better long-term survival and lower hospitalization costs than those who underwent d-CRT and surgery, with a similar rate of severe complications occurring.