Perioperative outcomes of esophagectomy after doublet versus docetaxel-based triplet neoadjuvant chemotherapy in older patients: A nationwide inpatient database study in Japan

IF 2.9 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Yuki Hirano, Takaaki Konishi, Hidehiro Kaneko, Satoru Matsuda, Hirofumi Kawakubo, Yuya Kimura, Hiroki Matsui, Kiyohide Fushimi, Hiroyuki Daiko, Osamu Itano, Hideo Yasunaga, Yuko Kitagawa
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引用次数: 0

Abstract

Background

Although docetaxel-based triplet neoadjuvant chemotherapy has yielded promising results for locally advanced esophageal cancer, there are concerns that the triplet regimen can increase perioperative adverse events in older patients. This retrospective study assessed the perioperative outcomes following doublet or docetaxel-based triplet chemotherapy and esophagectomy in older patients.

Methods

The data of patients aged 70–79 years who received cisplatin and 5-fluorouracil (CF) or docetaxel, cisplatin, and 5-fluorouracil (DCF) before esophagectomy were extracted from a nationwide Japanese inpatient database (April 2012–March 2022). The primary outcomes were major and respiratory complications. The secondary outcomes included anastomotic leakage, 30-day unplanned readmission, and 30- and 90-day mortality. Analyses were conducted using overlap propensity score weighting, propensity score matching, and instrumental variable methods to adjust for potential confounders.

Results

Of 5229 eligible patients, 3457 (66%) and 1772 (34%) patients received neoadjuvant CF and DCF, respectively. Major and respiratory complications occurred in 5229 (40%) and 1388 (27%) patients, respectively. After overlap weighting, DCF was not associated with a higher frequency of major (odds ratio 0.99 [95% confidence interval 0.87–1.12]) and respiratory complications (odds ratio 1.04 [0.90–1.19]) compared with CF. The frequencies of anastomotic leakage, 30-day unplanned readmission, and 30- and 90-day mortality did not differ between the groups. Propensity score matching and instrumental variable analyses yielded similar results.

Conclusions

Neoadjuvant DCF was not associated with a higher frequency of perioperative adverse events compared with CF after esophagectomy in patients aged 70–79 years.

Abstract Image

老年患者食管切除术后双药组与多西他赛为基础的三药组新辅助化疗的围手术期结果:日本一项全国住院患者数据库研究
尽管多西他赛为基础的三联新辅助化疗在局部晚期食管癌治疗中取得了令人满意的结果,但人们担心三联方案可能增加老年患者围手术期不良事件。本回顾性研究评估了老年患者双药或多西他赛为基础的三药化疗和食管切除术的围手术期结果。方法从日本全国住院患者数据库(2012年4月- 2022年3月)中提取食管切除术前接受顺铂+ 5-氟尿嘧啶(CF)或多西他赛+顺铂+ 5-氟尿嘧啶(DCF)治疗的70-79岁患者的数据。主要结局为主要并发症和呼吸系统并发症。次要结局包括吻合口漏、30天意外再入院、30天和90天死亡率。使用重叠倾向评分加权、倾向评分匹配和工具变量方法进行分析,以调整潜在的混杂因素。结果在5229例符合条件的患者中,分别有3457例(66%)和1772例(34%)患者接受了新辅助CF和DCF。分别有5229例(40%)和1388例(27%)患者出现严重并发症和呼吸系统并发症。重叠加权后,与CF相比,DCF与严重并发症(优势比0.99[95%可信区间0.87-1.12])和呼吸并发症(优势比1.04[0.90-1.19])的频率无关。吻合口漏、30天非计划再入院以及30天和90天死亡率的频率在两组之间没有差异。倾向评分匹配和工具变量分析得出了类似的结果。结论在70-79岁的患者中,与CF相比,新辅助DCF与食管切除术后围手术期不良事件的发生率无关。
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来源期刊
Annals of Gastroenterological Surgery
Annals of Gastroenterological Surgery GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.30
自引率
11.10%
发文量
98
审稿时长
11 weeks
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