Chemo-radiation With or Without Surgery for Resectable Esophageal Cancer: An Analysis of Survival among 11,122 Patients in the National Cancer Data Base (NCDB) 公开

Naik, Kushal (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/n296wz33c?locale=zh
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Abstract

Background : Locally advanced resectable esophageal cancers (rEC) are managed either with concurrent chemo-radiation followed by surgery (CRSx) or concurrent chemo-radiation alone (cCR). There is insufficient evidence comparing the overall survival (OS) of these two groups in a large population.

Methods : The National Cancer Data Base (NCDB) was queried for rEC cases diagnosed from 2003 to 2011. Patients with previous cancers, cervical rEC, clinical stage T1N0 or metastatic disease were excluded. cCR was defined as chemotherapy and radiotherapy given within 30 days of each other. CRSx was defined as cCR followed by surgical resection within 90 days of initiation of cCR. The overall survival in the two groups was compared using Kaplan-Meier methods and extended Cox-proportional hazard models.

Results : A total of 11,122 eligible patients were identified; of those, 8,091 (72.7%) received cCR and the rest were treated with CRSx. The odds of receiving CRSx was higher among patients with stage II disease, adenocarcinoma, lesions of lower third of esophagus, private insurance, and those living more than 25 miles away or in areas with higher median income or greater proportion of high school-educated residents. Patients over 70 years of age, females, African-Americans, those with (two or more) co-morbidities, or those treated at community programs were most likely to receive cCR alone. After adjusting for confounders the hazard ratio (HR) for CRSx compared to cCR alone was 0.66 (95% confidence interval [CI]: 0.45-0.97, p=0.03). In a propensity-score matched analysis the corresponding HR was 0.50 (95% CI: 0.46-0.54, p<0.001).

Conclusion : Data from the NCDB strongly support the inclusion of surgery after concurrent chemo-radiation for patients with locally advanced, resectable esophageal cancer.

Table of Contents

Background: ......................................................................................................................... 1

Methods: .............................................................................................................................. 2

Results: ............................................................................................................................... 5

Discussion: ........................................................................................................................... 7

References: ......................................................................................................................... 10

Figures and Tables: ............................................................................................................... 14

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