近日，北京大学柯杨等研究人员合作发现社区预防和标准化临床治疗共同改善癌症预后。2024年11月7日，国际知名学术期刊《科学通报》在线发表了这一成果。

研究人员在两个中国中心连续招募了13255名食管鳞状细胞癌（ESCC）患者：北方中心位于高风险地区，实施了丰富的筛查项目；南方中心则位于非高风险地区，临床实践得到改善。研究人员进行了中心间比较、中心内纵向比较和模拟分析，研究了肿瘤分期下调和高质量临床治疗对总体生存率（OS）的影响。在12.52年的随访期内，北方中心的中位生存期高于南方中心（6.22年 vs 3.15年；HR调整=0.73，95% CI: 0.69–0.77）。

中介分析表明，其OS优势主要（77.7%）归因于早期TNM分期（0–II期：51.3% vs 24.6%）。在时间性分析中，南方中心患者的生存期逐渐改善（2015–2018年 vs 2009–2014年：3.58年 vs 2.93年；HR调整=0.86，95% CI: 0.79–0.94），这与治疗相关指标的进展一致（出院诊断中TNM分期完整性[从53.7%到99.6%]、微创食管切除术采用率[从0.0%到51.1%]、右胸食管切除术采用率[从12.4%到86.4%]等）。

模拟分析进一步表明，结合肿瘤分期下调和高质量治疗将带来最佳生存结果。肿瘤分期下调和高质量临床治疗对ESCC患者生存具有联合影响。因此，建立一个将癌症预防与最佳临床治疗相结合的综合策略，对于减轻ESCC负担至关重要。

据悉，在中国，减少ESCC沉重负担的努力已取得广泛进展。然而，预防和治疗对ESCC患者长期OS的联合影响仍不完全明了。

附：英文原文

Title: Community prevention and standardized clinical treatment jointly improve cancer outcome: Real-world evidence from an esophageal cancer patient cohort study

Author: Zhonghu He f, Yang Ke f

Issue&Volume: 2024/11/07

Abstract: Extensive efforts have been put into reducing the heavy burden of esophageal squamous cell carcinoma (ESCC) in China. However, the joint impact of prevention and treatment on the long-term overall survival (OS) of ESCC patients remains largely unknown. We consecutively recruited 13,255 ESCC patients from two Chinese centers: the Northern center, located in a high-risk area with abundant screening programs; and the Southern center, situated in a non-high-risk area with improved clinical practices. Inter-center comparison, longitudinal intra-center comparison, and a simulation analysis were conducted to investigate the influence of tumor downstaging and high-quality clinical treatment on OS. During a follow-up period of 12.52 years, the Northern center exhibited higher median survival than the Southern center (6.22 vs. 3.15 years; HRadjusted = 0.73, 95% CI: 0.69–0.77). Mediation analysis demonstrated that its OS advantage was largely (77.7%) attributed to earlier TNM stage (stage 0–II: 51.3% vs. 24.6%). In temporal analyses, patient survival in the Southern center gradually improved (median survival during 2015–2018 vs. 2009–2014: 3.58 vs. 2.93 years; HRadjusted = 0.86, 95% CI: 0.79–0.94), coinciding with the progress of treatment-related indices (completeness of TNM staging in discharge diagnosis [from 53.7% to 99.6%], adoption of minimally invasive esophagectomy [from 0.0% to 51.1%] and right thoracic esophagectomy [from 12.4% to 86.4%], etc.). Simulation analysis further demonstrated that integrating both downstaging and high-quality treatment would lead to the best survival. Tumor downstaging and high-quality clinical treatment have a joint impact on ESCC patient survival. Establishing a comprehensive strategy that integrates cancer prevention with optimal clinical treatment is crucial for alleviating the ESCC burden.

DOI: 10.1016/j.scib.2024.11.005

Source: https://www.sciencedirect.com/science/article/pii/S209592732400803X