Long-Term Survival Outcomes and Comparison of Different Treatment Modalities for Stage I-III Cervical Esophageal Carcinoma

Lu, Yanxia; Xu, Chenwang; Wang, Haitao; Song, Tao; Wu, Shixiu; Liang, Xiaodong; Xu, Hongen

doi:10.3389/fmed.2021.714619

Cited by 5 publications

(7 citation statements)

References 35 publications

(40 reference statements)

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“…To balance the enrolled patients and reduce the selection bias of baseline characteristics between the two groups, we performed a PSM analysis for covariates, including marital status, and the 2014 FIGO stage at a ratio of 1:10 for AC: SCC. The PSM analysis was conducted as described in our previous studies (14,15). A univariate analysis was employed using the cumulative incidence function (CIF) to determine the probability of each covariate and Gray's test to evaluate the difference between groups.…”

Section: Discussionmentioning

confidence: 99%

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Survival Comparison Between Squamous Cell Carcinoma and Adenocarcinoma for Radiotherapy-Treated Patients with Stage IIB-IVA Cervical Cancer

Chen

Shi

et al. 2022

Front. Oncol.

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ObjectiveTo compare the prognostic significance of adenocarcinoma (AC) with squamous cell carcinoma (SCC) on overall survival (OS) in patients with stage IIB-IVA cervical cancer (CC) treated by external beam radiotherapy (EBRT) and brachytherapy (BRT) with/without chemotherapy registered in the Surveillance, Epidemiology, and End Results database.MethodsData of eligible patients were extracted between 2004 and 2016. A univariate analysis was conducted using the cumulative incidence function (CIF) by considering competing events and compared using Gray’s test. The significant variables in univariate analysis were further evaluated in a multivariate analysis performed with the Fine-Gray regression model. Propensity score matching (PSM) analysis was also employed to reconfirm the results found in the present study.ResultsA total of 2,243 patients with SCC and 176 patients with AC were extracted from the database. The 5-year OS rates were 57.8% in the SCC group and 52.8% in the AC group. 149 patients died of causes other than CC—considered as competing events. Compared with the SCC group, patients diagnosed with AC had statistically significant worse 5-year OS rate before and after PSM. In the multivariate Fine-Gray regression model, the histological subtype of AC was proven as an independent prognostic factor associated with poorer OS before [hazard ratio (HR) = 1.340; 95% confidence interval (CI): 1.081-1.660; P = 0.007] and after [HR = 1.376; 95% CI: 1.107-1.711; P = 0.004] PSM.ConclusionsThe histological subtype of AC is significantly correlated with impaired OS as an independent prognostic variable in patients with stage IIB-IVA CC who received EBRT and BRT compared to patients with SCC. Future studies should incorporate effective and individualized treatment strategies into clinical decision-making to improve the unsatisfactory survival outcomes for patients with AC.

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Section: Discussionmentioning

confidence: 99%

“…The cut-off point for the age at diagnosis was set at 70-years old as adopted by other SEER studies (11,12). Classification of the other variables was assorted according to our previous studies (13,14).…”

Section: Data Processingmentioning

confidence: 99%

Survival Comparison Between Squamous Cell Carcinoma and Adenocarcinoma for Radiotherapy-Treated Patients with Stage IIB-IVA Cervical Cancer

Chen

Shi

et al. 2022

Front. Oncol.

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“…Surgical treatment still has a great risk of major complications and a high morbidity and mortality rate [18][19] . Recently, a retrospective study including 347 cervical esophageal cancer patients from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database was done to investigate the survival and prognostic factors of different treatment modalities [20] . The study showed that no signi cant survival bene t was obtained from triple therapy with surgery over double therapy (median OS time: 31 months versus 20 months; P = 0.184).…”

Section: Discussionmentioning

confidence: 99%

Elective nodal irradiation versus involved-field irradiation for stage Ⅱ-Ⅳ cervical esophageal squamous cell carcinoma patients undergoing definitive concurrent chemoradiotherapy: a retrospective propensity study with eight-year survival outcomes

Wang

Zhang

et al. 2022

Preprint

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Background Definitive concurrent chemoradiotherapy (dCCRT) is suggested as the standard treatment for cervical esophageal squamous cell carcinoma (CESCC). This retrospective propensity study compared the eight-year survival outcomes and acute treatment toxicities of these patients treated with elective nodal irradiation (ENI) versus involved-field irradiation (IFI). Materials and Methods Patients with stage Ⅱ-Ⅳ CESCC treated with dCCRT at the Fourth Hospital of Hebei Medical University between January 1, 2007 and December 31, 2020 were enrolled in the study. All the patients were restaged according to the American Joint Commission (AJCC) 8th edition criteria. The propensity score matching (PSM) was used to minimize the effects of treatment selection bias and potential confounding factors including sex, age, ECOG score, clinical T stage (cT), clinical N stage (cN), clinical TNM stage (cTNM) and radiation dose between the ENI group and IFI group. Survival and the prognostic factors were evaluated. Results The 131 eligible patients underwent ENI (60 patients, 45.8%) or IFI (71 patients, 54.2%). The median follow-up time was 91.1 months (range, 23.8–182.0 months) for all the patients. The median OS, 1-, 3-, 5-, and 8-year OS rates were 44.4 months, 87.8%, 55.1%, 38.3%, and 27.2%, respectively. After PSM, there were 49 patients in each group. The median OS, 1-, 3-, 5-, and 8-year OS rates for ENI and IFI group were 32.0 months, 83.7%, 48.5%, 38.5% and 31.1% versus 45.2 months, 89.8%, 52.5%, 37.5%, 26.1%, respectively (P = 0.966; HR 0.99, 95%CI 0.61–1.61). Similar locoregional control was obtained in both groups. The tendency of leukocytopenia and neutropenia was higher in ENI than in IFI (59.2% versus 38.8%; P = 0.068 and 30.6% versus 14.3%; P = 0.089) at the end of dCCRT. Conclusion Cervical esophageal squamous cell carcinoma patients undergoing definitive concurrent chemoradiotherapy has a satisfactory prognosis with organ conservation. The involved-field irradiation might be a better alternative owing to similar overall survival outcomes and local control with less toxicity of myelosuppression.

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“…To reduce selection bias of baseline characteristics between the two groups, we performed a PSM analysis at a ratio of 1:1 for covariates, including marital status, race, tumor size, 2014 FIGO stage, RT, and CT by the R “ MatchIt ” package. The PSM analysis was performed as described in our previous studies [ 27 , 28 ]. Survival curves were estimated using the Kaplan–Meier analysis and compared with the log-rank test.…”

Section: Methodsmentioning

confidence: 99%

Stage IIB-IVA cervix carcinoma in elderly patients treated with radiation therapy: a longitudinal cohort study by propensity score matching analysis

Shou

Wan

et al. 2023

BMC Women's Health

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Objective We aimed to evaluate the treatment modality and prognostic impact of the age at diagnosis on stage IIB-IVA cervix carcinoma (CC) patients who received radiotherapy (RT).The evaluation was performed using the Surveillance, Epidemiology, and End Results (SEER) database. Patients and methods From the SEER database, we included the patients with a histopathological diagnosis of CC between 2004 and 2016. Subsequently, we compared the treatment outcomes between patients aged ≥ 65 years (OG) and < 65 years (YG) by propensity score matching (PSM) analysis and Cox proportional hazard regression models. Results The data of 5,705 CC patients were obtained from the SEER database. We observed that the OG patients were significantly less likely to receive chemotherapy, brachytherapy, or combination treatment compared to the YG (P < 0.001). Further, the advanced age at diagnosis was an independent prognostic factor associated with decreasing overall survival (OS) before and after PSM. Even in the subgroup analysis of patients who received trimodal therapy, an advanced age had a significant negative impact on OS compared to their younger counterparts. Conclusion Advanced age is associated with less aggressive treatment regimens and is independently associated with impaired OS for stage IIB-IVA CC patients who received RT. Hence, future studies should incorporate geriatric assessment into clinical decision-making to select appropriate and effective treatment strategies for elderly CC patients.

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Long-Term Survival Outcomes and Comparison of Different Treatment Modalities for Stage I-III Cervical Esophageal Carcinoma

Cited by 5 publications

References 35 publications

Survival Comparison Between Squamous Cell Carcinoma and Adenocarcinoma for Radiotherapy-Treated Patients with Stage IIB-IVA Cervical Cancer

Survival Comparison Between Squamous Cell Carcinoma and Adenocarcinoma for Radiotherapy-Treated Patients with Stage IIB-IVA Cervical Cancer

Elective nodal irradiation versus involved-field irradiation for stage Ⅱ-Ⅳ cervical esophageal squamous cell carcinoma patients undergoing definitive concurrent chemoradiotherapy: a retrospective propensity study with eight-year survival outcomes

Stage IIB-IVA cervix carcinoma in elderly patients treated with radiation therapy: a longitudinal cohort study by propensity score matching analysis

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