Comparison of safety and efficacy between chemoradiotherapy and chemotherapy after R0 resection in pN+ esophageal squamous cell carcinoma patients

doi:10.3760/cma.j.cn371439-20220325-00063

Abstract

Abstract: ObjectiveTo investigate the safety and efficacy of chemoradiotherapy compared with chemotherapy after R0 excision in pN₊ esophageal squamous cell carcinoma （ESCC） patients. Methods A retrospective analysis was performed on the pathological data of 99 pN₊ESCC patients who underwent radical esophagectomy with R0 resection in Renmin Hospital of Wuhan University from January 2017 to December 2020. According to postoperative adjuvant treatment methods, the patients were divided into chemo-radiotherapy group （n=41） and chemotherapy group （n=58）. The main outcome measures were disease-free survival （DFS）, overall survival （OS） and the incidences of treatment-related adverse events. Kaplan-Meier method was used to draw the survival curve accompanied with log-rank test. Cox regression model was used to analyze the prognostic factors. Results The median DFS and OS of 99 patients were 20.0 months and 28.0 months respectively. The 1- and 3-year DFS rates were 60.8% and 34.5% respectively. The 1- and 3-year OS rates were 83.5% and 40.2% respectively. The median DFS was 39.0 months in the chemoradiotherapy group and 10.0 months in the chemotherapy group, and the 1- and 3-year DFS rates were 79.4% vs. 48.3% and 57.3% vs. 24.5% respectively, with a statistically significant difference （χ²=12.27, P<0.001）. The median OS in the chemoradiotherapy group was not reached, and 21.0 months in the chemotherapy group, and the 1- and 3-year OS rates of the chemoradiotherapy group and chemotherapy group were 92.1% vs. 75.9% and 60.8% vs. 27.3%, with a statistically significant difference （χ²=11.12, P=0.001）. Univariate analysis showed that pN stage （HR=0.58, 95%CI： 0.34-0.97, P=0.038）, nerve invasion （HR=1.88, 95%CI： 1.11-3.20, P=0.020） and adjuvant therapy （HR=0.37, 95%CI： 0.21-0.67, P<0.001） were independent influencing factors of DFS in pN₊ESCC patients. Adjuvant therapy （HR=0.33, 95%CI： 0.17-0.66, P=0.001） was an independent factor influencing OS in pN₊ESCC patients. Multivariate analysis showed that pN stage （HR=0.54, 95%CI： 0.30-0.97, P=0.038） and adjuvant therapy （HR=0.38, 95%CI： 0.21-0.69, P=0.001） were independent prognostic factors of DFS. Adjuvant therapy （HR=0.34, 95%CI： 0.17-0.69, P=0.003） was an independent prognostic factor for OS. During adjuvant therapy, there were statistically significant differences in the incidences of leukopenia [65.85% （27/41） vs. 31.03% （18/58）, χ²=11.75, P=0.001], thrombocytopenia [29.27% （12/41） vs. 10.34% （6/58）, χ²=5.78, P=0.016], radioactive esophagitis [21.95% （9/41） vs. 0 （0/58）, χ²=11.48, P=0.001], and radioactive pneumonia [21.95% （9/41） vs. 0 （0/58）, χ²=11.48, P=0.001] between the two groups. Conclusion Compared with chemotherapy, chemoradiotherapy can significantly improve DFS and OS of pN₊ESCC patients with R0 resection after radical surgery, and the adverse reactions can be tolerated. pN stage and adjuvant therapy are independent prognostic factors for DFS, and adjuvant therapy is an independent prognostic factor for OS.

Key words: Esophageal neoplasms, Neoplasms, squamous cell, Chemoradiotherapy

Xia Lingling, Chen Yongshun, Li Bin, Ning Tingting, Zhang Caiyutian. Comparison of safety and efficacy between chemoradiotherapy and chemotherapy after R0 resection in pN₊ esophageal squamous cell carcinoma patients[J]. Journal of International Oncology, 2022, 49(6): 334-339.

Figures/Tables 6

References 16

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一般临床特征	例数	放化疗组（n=41）	化疗组（n=58）	χ²值	P值
年龄（岁）
≤65	55	26	29	1.75	0.186
>65	44	15	29	1.75	0.186
性别
男	88	36	52	<0.01	>0.999
女	11	5	6	<0.01	>0.999
肿瘤部位
上或中	74	31	43	0.03	0.868
下	25	10	15	0.03	0.868
pN分期
N₁	41	18	23	0.18	0.673
N_2-3	58	23	35	0.18	0.673
pT分期
T_1-2	15	8	7	1.04	0.309
T_3-4	84	33	51	1.04	0.309
病理分期
ⅡB~ⅢB	77	33	44	0.30	0.586
ⅣA	22	8	14	0.30	0.586
神经侵犯
有	51	17	34	2.83	0.092
无	48	24	24	2.83	0.092
血管浸润
有	43	14	29	2.46	0.117
无	56	27	29	2.46	0.117
分化程度
低	13	5	8	0.05	0.817
中或高	86	36	50	0.05	0.817

一般临床特征	DFS			OS
一般临床特征	HR值	95%CI	P值	HR值	95%CI	P值
年龄（≤65岁/>65岁）	0.93	0.56~1.56	0.781	1.04	0.58~1.87	0.895
性别（男/女）	1.34	0.53~3.35	0.536	1.22	0.44~3.42	0.702
肿瘤部位（上或中/下）	0.96	0.52~1.75	0.884	0.71	0.37~1.36	0.301
pN分期（N₁/N_2-3）	0.58	0.34~0.97	0.038	0.81	0.45~1.44	0.471
pT分期（T_1-2/ T_3-4）	0.88	0.43~1.81	0.735	0.72	0.31~1.70	0.454
病理分期（ⅡB~ⅢB/ⅣA）	0.57	0.33~1.01	0.052	0.70	0.37~1.33	0.278
神经侵犯（有/无）	1.88	1.11~3.20	0.020	1.57	0.88~2.82	0.130
血管浸润（有/无）	1.63	0.97~2.74	0.064	1.28	0.72~2.28	0.408
分化程度（低/中或高）	1.01	0.46~2.22	0.986	1.47	0.53~4.12	0.460
辅助治疗方法（放化疗/化疗）	0.37	0.21~0.67	<0.001	0.33	0.17~0.66	0.001

一般临床特征	DFS			OS
一般临床特征	HR值	95%CI	P值	HR值	95%CI	P值
pN分期（N₁/N_2-3）	0.54	0.30~0.97	0.038	0.75	0.40~1.41	0.639
病理分期（ⅡB~ⅢB/ⅣA）	0.81	0.23~2.77	0.730	0.96	0.27~3.35	0.943
神经侵犯（有/无）	1.56	0.87~2.81	0.134	1.36	0.72~2.58	0.342
血管浸润（有/无）	1.01	0.55~1.85	0.987	0.91	0.47~1.75	0.774
辅助治疗方法（放化疗/化疗）	0.38	0.21~0.69	0.001	0.34	0.17~0.69	0.003

不良反应	放化疗组（n=41）	化疗组（n=58）	χ²值	P值
白细胞减少	27（65.85）	18（31.03）	11.75	0.001
中性粒细胞减少	4（9.76）	6（10.34）	<0.01	>0.999
血小板减少	12（29.27）	6（10.34）	5.78	0.016
血红蛋白减少	18（43.90）	19（32.76）	1.27	0.259
恶心呕吐	6（14.63）	14（24.14）	1.35	0.246
低钾	9（21.95）	7（12.07）	1.73	0.188
肝功能异常	4（9.76）	7（12.07）	0.01	0.971
低蛋白血症	4（9.76）	7（12.07）	0.01	0.971
乏力	2（4.88）	4（6.90）	˂0.01	˃0.999
放射性食管炎	9（21.95）	0（0）	11.48	0.001
放射性肺炎	9（21.95）	0（0）	11.48	0.001