The optimal management of patients with locally advanced esophageal adenocarcinoma is unclear. Neoadjuvant chemoradiotherapy followed by esophagectomy (trimodality therapy) is supported as a standard of care, but definitive chemoradiotherapy is frequently given in practice to patients who may have been surgical candidates. This multi-institutional retrospective cohort study compared the outcomes of consecutive patients diagnosed with stage II to IVA esophageal adenocarcinoma between 2004 and 2018 who planned to undergo trimodality therapy or definitive chemoradiotherapy. A total of 493 patients were included, of whom 435 intended to undergo trimodality therapy and 56 intended to undergo definitive chemoradiotherapy. After a median follow-up of 7.3 years, trimodality therapy was associated with a lower risk of locoregional failure (5-year risk, 30.5% vs. 61.3%; HR, 0.39; 95% CI, 0.24–0.62;p<0.001) but not distant metastases (5-year risk, 58.2% vs. 53.9%; HR, 1.21; 95% CI, 0.77–1.91;p=0.40). There were no differences in overall survival (HR, 0.78; 95% CI, 0.56–1.09;p=0.14) or cancer-specific survival (HR, 0.83; 95% CI, 0.57–1.21;p=0.33). Findings were consistent on propensity score-matched sensitivity analyses. In conclusion, trimodality therapy was associated with a lower risk of locoregional failure, but this did not translate into a significantly lower risk of distant failure or improved survival. Further studies are required to accurately estimate the trade-offs between the two treatment strategies.
局部晚期食管腺癌患者的最佳治疗方案尚不明确。新辅助放化疗联合食管切除术（三联疗法）被确立为标准治疗方案，但在临床实践中，许多本可接受手术的患者常被施以根治性放化疗。这项多机构回顾性队列研究比较了2004年至2018年间诊断为II至IVA期食管腺癌、计划接受三联疗法或根治性放化疗的连续患者治疗结局。共纳入493例患者，其中435例计划接受三联疗法，56例计划接受根治性放化疗。中位随访7.3年后，三联疗法与较低的局部区域复发风险相关（5年风险：30.5% vs. 61.3%；HR=0.39；95%CI：0.24-0.62；p<0.001），但未降低远处转移风险（5年风险：58.2% vs. 53.9%；HR=1.21；95%CI：0.77-1.91；p=0.40）。两组在总生存期（HR=0.78；95%CI：0.56-1.09；p=0.14）和癌症特异性生存期（HR=0.83；95%CI：0.57-1.21；p=0.33）方面无显著差异。倾向评分匹配敏感性分析结果与上述结论一致。综上所述，三联疗法可降低局部区域复发风险，但未能显著减少远处转移风险或改善生存率。需进一步研究以精确评估两种治疗策略的获益权衡。
肿瘤(癌症)患者之家