Stop Canceling Surgery for Esophageal Cancer: An Analysis of Treatment Related Mortality in 60 000 Patients.

IF 1.9 3区医学 Q3 ONCOLOGY

Journal of Surgical Oncology Pub Date : 2025-09-14 DOI:10.1002/jso.70085

Brian Housman, Shubham Gulati, Ashwin Kulshrestha, Matthew Untalan, Tara Ivic-Pavlicic, Stephanie Tuminello, Karyn A Goodman, Emanuela Taioli, Raja Flores

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引用次数: 0

Abstract

Background and methods: Surgical esophagectomy is falsely regarded as contributing little survival in resectable, early-stage disease in favor of nonsurgical treatment with definitive chemoradiation (dCR). We examine surgery in treatment by evaluating large-scale trends in mortality. The SEER database was queried for esophageal cancer patients from 2004 to 2020. Total of 59 754; 19 806 squamous and 34 484 adenocarcinoma. The primary outcome was the hazard ratio for overall survival defined as time from diagnosis-to-death. Differences between patients were assessed using χ² tests for categorical variables and t-tests for continuous variables. Difference in survival by histology was assessed using Kaplan-Meier curves and Cox Proportional Hazards models.

Results: A total of 47 170 (78.9%) did not undergo surgery and 12 584 (21.1%) received surgery. The hazard ratio for patients undergoing dCR for SCC was 1.929. The hazard ratio for treatment with dCR compared to chemoradiation-followed-by-surgery (CRS) was 2.151 and for adenocarcinoma 2.386. Further analyses highlight groups under similar clinical conditions; including multivariate analysis, T-Stage, overall stage, surgical era, and surgery refusal. In every category, the risk of mortality was higher in dCR compared to CRS.

Conclusions: Surgery combined with chemoradiation, and/or surgery alone, confers a significant survival benefit over dCR in resectable patients.

Discussion: Surgery should be considered early in medically fit patients with operable disease.

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食管癌患者停止取消手术：6万例治疗相关死亡率分析

背景和方法：在可切除的早期疾病中，手术食管切除术被错误地认为对生存率的贡献很小，而非手术治疗和明确的放化疗（dCR）更受欢迎。我们通过评估死亡率的大规模趋势来检查手术治疗。对2004年至2020年食管癌患者的SEER数据库进行了查询。共59 754人；鳞状癌19 806例，腺癌34 484例。主要结局是总生存的风险比，定义为从诊断到死亡的时间。分类变量采用χ2检验，连续变量采用t检验。采用Kaplan-Meier曲线和Cox比例风险模型评估组织学生存率差异。结果：未行手术47 170例（78.9%），行手术12 584例（21.1%）。SCC患者行dCR的风险比为1.929。与手术后放化疗（CRS）相比，dCR治疗的风险比为2.151，腺癌的风险比为2.386。进一步分析显示临床条件相似的组；包括多变量分析、t分期、总分期、手术时间和手术拒绝。在所有类别中，与CRS相比，dCR的死亡风险更高。结论：与可切除的dCR患者相比，手术联合放化疗和/或单独手术可获得显著的生存优势。讨论：医学上适合手术疾病的患者应尽早考虑手术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Surgical Oncology 医学-外科

CiteScore

4.70

自引率

4.00%

发文量

367

审稿时长

2 months

期刊介绍： The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.