| Background Early symptoms of esophageal cancer are insidious,and are often locally advanced as soon as they are diagnosed.Despite surgery,the 5-year survival rate is still less than 30%.A large part of its treatment failure is due to local recurrence.Postoperative radiotherapy can improve its local tumor control rate,but the optimal dose of postoperative adjuvant radiotherapy has not yet reached a consensus.This study analyzed the influencing factors of locally advanced esophageal cancer after postoperative radiotherapy,and applied propensity score matching method to analyze the different doses(low dose 50 Gy group and high dose >50Gy group)radiotherapy in the postoperative local advanced ESCC(Esophageal Squamous Cell Carcinoma)differences in efficacy in patients.Methods A collection of 199 patients with locally advanced esophageal squamous cell carcinoma admitted to our hospital from 2008 to 2018 were collected.All patients received postoperative radiotherapy.According to different postoperative radiotherapy doses,they were divided into low-dose group(50Gy)and high-dose group.Dose group(>50Gy).Among them,there were 144 cases in the low-dose group,55 cases in the high-dose group,and 35 cases in both the low-dose group and the high-dose group after propensity score matching.All radiotherapy techniques adopt IMRT(Intensity-Modulated Radiotherapy Technique).The main study endpoints are Overall Survival(OS)and Progression-Free Survival(PFS).Statistical analysis mainly uses SPSS 25.0 statistical software,and Kaplan-Meier method is used to analyze OS and PFS;Log-Rank test is used for single-factor analysis;Cox model is used for multi-factor analysis,with P value < 0.05 is considered statistically different.The differences in clinical characteristics between the two groups were tested by Pearson’s chi-square test.In order to reduce the inherent bias of the retrospective study and improve the reliability of the results,this study used the Propensity Score Matching(PSM)method to balance the covariate differences between the two groups of patients on the clinical baseline characteristics of the two groups,and analyzed the Kaplan-Maier method.The survival of the two groups before and after the match.Results1)Univariate analysis showed that pathological N staging,vascular tumor thrombus,and radiation dose are important factors influencing the overall survival of locally advanced ESCC patients with postoperative radiotherapy.Pathological N staging,pathological M staging,vascular tumor thrombus,and radiation dose are important factors influencing the progression-free survival of locally advanced ESCC patients with postoperative radiotherapy.Subgroup analysis found that the pre-set OS subgroup analysis results tend to have a survival advantage in the low-dose group,and the hazard ratio(HR)is less than 1.All P except T4 and preoperative neoadjuvant chemotherapy subgroups the values are all less than0.05,and the difference is statistically significant.The pre-set PFS subgroup analysis results all tend to have a survival advantage in the low-dose group,with HR < 1.Except for the T4,N3,preoperative chemotherapy and the subgroup receiving more than 2 cycles of chemotherapy after surgery,the P value is less than0.05.The difference is statistically significant.2)The results of multivariate analysis showed that pathological N stage,vascular tumor thrombus,and radiation dose were independent risk factors for OS and PFS in patients with locally advanced esophageal squamous cell carcinoma treated with postoperative radiotherapy.3)Before matching,the median OS of the low-dose group was 108.4months,and the median OS of the high-dose group was 31 months.The 1-year survival rate of the two groups was 95.1 vs.85.5%,and the 3-year survival rate was77.7 vs.45.1%,the 5-year survival rate was 61.5 vs.33.7%(P<0.0001),and the difference in survival between the two groups was statistically significant.Before matching,the median PFS of the low-dose group was 106 months,the median PFS of the high-dose group was 17 months,the 1-year PFS of the two groups was 91.7vs.67.3%,and the 3-year PFS was 65.3 vs.41.8%.The 5-year PFS was 56.0 vs.26.2%(P<0.0001),and the difference in PFS between the two groups was statistically significant.After matching,the median OS in the low-dose group was not reached,and the median OS in the high-dose group was 37.5 months.The1-year survival rate of the two groups was 97.1 vs.85.7%,the 3-year survival rate was 88.6 vs.51.4%,and the 5-year survival rate was 77.8 vs.40.4%(P = 0.0001),and the difference between the two groups was statistically significant.After matching,the median PFS in the low-dose group was not reached,and the median PFS in the high-dose group was 19 months.The 1-year PFS of the two groups was97.1 vs.74.3%,the 3-year PFS was 80.0 vs.42.9%,and the 5-year PFS was 66.9.vs.30.6%(P = 0.0001),the difference between the two groups was statistically significant.Subgroup analysis after matching showed that p T1-3,p N0-2,and low-dose esophageal squamous cell carcinoma cells with negative postoperative margins had higher survival,P<0.05.There was no difference in survival in the other subgroups.Conclusions Pathological N stage,vascular tumor thrombus,and postoperative radiotherapy dose are independent prognostic factors that affect OS and PFS in patients with locally advanced esophageal squamous cell carcinoma after radiotherapy.Combined with the analysis of propensity score matching method,it is shown that postoperative 50 Gy has higher OS and PFS than higher dose postoperative radiotherapy.Sub-group analysis shows that most subgroups of high and low dose postoperative radiotherapy have equivalent effects the high survival of the low-dose group was mainly reflected in the three conditions of p T1-3,p N0-2 and negative postoperative margins. |
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