“星星”小引
又到周一文献时间，上一期为大家报道了食管癌早期的治疗趋势和术前的新辅助化疗，本期将给大家带来食管癌相关的治疗方式（单纯放化疗，单纯手术，术前辅助治疗，术后辅助治疗）与预后的关系分析，以及微创食管胃切除术（MIE）的预后是否取决于机构病例数量分析。一起来看这一期的“星”视角吧！
1
Analysis of the National Cancer DatabaseEsophageal Squamous Cell Carcinoma in the United States
Brandon C. Chapman1, MD, Michael Weyant2,MD, Sarah Hilton1, MD, Patrick W. Hosokawa3, BS, Martin D.McCarter1, MD, AnaGleisner1, MD, PhD, Nader D. Nader4, MD, PhD, Csaba Gajdos, MD.1*
1. Department of Surgery, University ofColorado at Denver, Aurora, Colorado
2. Department of Cardiothoracic Surgery,University of Colorado at Denver, Aurora, Colorado
3. Adult and Child Center for HealthOutcomes Research and Delivery Science (ACCORDS), Aurora, Colorado
4.Department of Anesthesiology, Universityof New York at Buffalo, Buffalo, New York
Background:Esophageal squamous cellcarcinoma (ESCC) has been poorly studied, approached with therapeutic nihilismand likely undertreated. We studied the impact of clinical and patient factorson the survival of ESCC in the US.
Methods:We selected patients with StageI-III ESCC from to using the National Cancer Database (NCDB).Patients were categorized into the following treatment modalities: (1) definitive chemoradiation (CR), (2)neoadjuvant therapy followed by esophageal resection (ER), (3) ER alone, and(4) ER followed by adjuvant therapy. Our main outcomemeasure was overall survival.
Results:We identified 11,229 patients withESCC undergoing definitive CR (78.6%), neoadjuvant therapy followed by ER(8.5%), ER alone (10.1%), and ER followed by adjuvant therapy (2.6%). Comparedto neoadjuvant therapy, both ER alone and definitive CR were associated withsignificantly increased mortality. Patients treated at high volume centers(>20), regardless of whether they underwent ER, had improved survival comparedto facilities performing 10-19, 5-9, and <5 ER per year.
Conclusions:Patients treated athigh-volume facilities were more likely to receive neoadjuvant therapy andthere was a significant inverse relationship between annual surgical volume andlong-term survival for both surgically and non-surgically treated Stage I-IIIESCC patients.
CITATION:Chapman BC, Weyant M, Hilton S, et al. Analysisof the National Cancer Database Esophageal Squamous Cell Carcinoma in theUnited States. Ann Thorac Surg. Jul 11. pii: S0003-4975(19)31006-9.
IF:3.919
DOI:10.1016/j.athoracsur..05.053.
美国国家癌症数据库食管鳞癌的分析
胸“星”外科学术团队兴趣小组成员吴希文译
目的和背景
目前关于食管鳞状细胞癌（ESCC）的研究较少，疗效较差。我们研究了在美国临床因素和患者因素对ESCC生存的影响。
方法
我们从国家癌症数据库(NCDB)挑选了到间I-III期的ESCC患者。患者按照以下几种治疗方式进行分类:(1)明确的放化疗(CR)。(2)新辅助治疗后进行食管切除术(ER)。(3)单纯ER。(4)ER后进行辅助治疗。主要的结果指标是总体生存率。
结果
纳入11,229例ESCC患者，包括行明确CR(78.6%),新辅助治疗后进行ER （8.5%），单纯ER（10.1%）, ER后进行辅助治疗（2.6%）。与新辅助治疗相比,单纯ER和明确CR患者死亡率显着增高。在大样本中心（>20）的患者，不管是否行ER，与每年进行ER次数为10-19,5-9,＜5的机构相比，生存率有所提高。
结论
在大样本中心接受治疗的患者更有可能接受新辅助治疗,对于手术和非手术治疗的I-III期ESCC患者，年外科手术量与长期生存率之间存在显着的反比关系。
2
Case Volume-to-Outcome Relationship in Minimally-InvasiveEsophagogastrectomy
Hai Salfity1, Lava Timsina3, Katherine Su1,DuyKhanh Ceppa2, Thomas Birdas2
Indiana University School of Medicine 1Departmentof General Surgery 2Department of Cardiothoracic Surgery 3Center for OutcomesResearch in Surgery
Background:Outcomes after openesophagectomy (OE) have been shown to depend on institution case volume. We aimto determine whether a similar relationship exists for minimallyinvasiveesophagogastrectomy (MIE).
Methods:Patients whohad OE or MIE (excluding robotic procdures) between and in theNational Cancer Database were included. Outcomes included 30- and 90-daymortality, length-of-stay, hospital readmission, margin positivity, and numberof lymph nodes harvested. Logistic and linear regression were used to adjustfor possible confounders including age, gender, tumor size, Charlson score,induction therapy, and type of institution (academic vs. community-based).
Results:We identified 2371 patients in theMIE group and 6285 patients in the OE group. In multivariate analysis, highcase volume was an independent predictor for lower 30-day, 90-day mortality,shorter length-of-stay, and higher rate of negative-margin resection in OE(P< 0.0001)
but not MIE. After quartile ranking of institutionsbased on volume, MIE outcomes were found to be better in institutions in thehighest volume quartile compared to those in the lowest (p<0.0001).
Conclusions:In this >
CITATION:Salfity H, Timsina L, Su K, et al. CaseVolume-to-Outcome Relationship in Minimally-Invasive Esophagogastrectomy. AnnThorac Surg. Jul 11. pii: S0003-4975(19)31007-0.
IF:3.919
DOI:10.1016/j.athoracsur..05.054.
微创食管胃切除术中病例数量与预后的关系
胸“星”外科学术团队兴趣小组成员廖新月译
目的和背景
开放性食管切除术(OE)的预后取决于机构病例的数量。本研究旨在确定微创食管胃切除术（MIE）是否也存在类似的关系。
方法
收集了国家癌症数据库中至行OE或MIE（不包括机器人手术）治疗的患者的资料，包括30天和90天的死亡率、住院时间、再入院率、切缘阳性和清扫淋巴结数目。使用logistic和线性回归方程对可能的混杂因素进行调整，包括年龄、性别、肿瘤大小、Charlson评分、诱导治疗和机构类型（以医院与社区为基础）。
结果
我们选定了MIE组2371例患者和OE组6285例患者进行研究分析。在多变量分析中，高病例量是OE组患者30天、90天死亡率较低、住院时间较短、切缘阴性率较高的独立预测因子（P<0.001），而MIE患者则无类似结果。根据病例数量对机构进行四分位排序后，发现最高四分位机构的MIE结果优于最低四分位机构(p<0.0001)。
结论
在本研究的数据集中，MIE术后结果与OE不同，与医院病例数量无关，手术方法可能会影响数量与结果的关系。因此病例数量对MIE长期预后的影响需进一步研究。
“星星”有语
基于美国国家癌症数据库，Brandon等人将纳入的11229例病人，按手术方式分为单纯放化疗、单纯手术、术前辅助治疗、术后辅助治疗四类，统计分析得出在接受食管切除术后进行辅助治疗，可提高患者长期生存率。Salfity等人从数据库中筛选出行OE与MIE的患者，分析其短期预后与病例数量的关系，与OE不同，MIE的短期预后与病例数量无关，长期预后有待进一步研究。
周一“星”视角 | 美国国家癌症数据库食管鳞癌治疗方式与预后分析 微创食管胃切除术病例数量与预后分析
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