Comparing the Efficacy of Carboplatin plus 5-Fluorouracil, Cisplatin plus 5-Fluorouracil, and Best Supportive Care for Advanced Esophageal Squamous Cell Carcinoma: A Propensity Score Analysis from a Tertiary Hospital in Southern Thailand
<b>Background</b>: Although cisplatin plus 5-fluorouracil (5-FU) is the standard first-line treatment for advanced-stage esophageal squamous cell carcinoma (ESCC), carboplatin was substituted for cisplatin in cisplatin-ineligible patients. The efficacy of carboplatin plus 5-FU for advanc...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-03-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/13/6/1735 |
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| author | Jirapat Wonglhow Panu Wetwittayakhlang Patrapim Sunpaweravong Chirawadee Sathitruangsak Arunee Dechaphunkul |
| author_facet | Jirapat Wonglhow Panu Wetwittayakhlang Patrapim Sunpaweravong Chirawadee Sathitruangsak Arunee Dechaphunkul |
| author_sort | Jirapat Wonglhow |
| collection | DOAJ |
| description | <b>Background</b>: Although cisplatin plus 5-fluorouracil (5-FU) is the standard first-line treatment for advanced-stage esophageal squamous cell carcinoma (ESCC), carboplatin was substituted for cisplatin in cisplatin-ineligible patients. The efficacy of carboplatin plus 5-FU for advanced-stage ESCC remains unreported. <b>Methods</b>: This retrospective study analyzed first-line treatment—carboplatin plus 5-FU, cisplatin plus 5-FU, or best supportive care (BSC)—in advanced-stage ESCC patients at a tertiary hospital in Thailand (2012–2022). Survival was assessed using the Kaplan–Meier method, compared via the log-rank test, and adjusted through propensity score matching. Significance was set at <i>p</i> < 0.05. <b>Results</b>: Of 256 patients, 39.9% received carboplatin plus 5-FU, 27.7% cisplatin plus 5-FU, and 32.4% BSC. Carboplatin was significantly associated with older age, poorer performance status, more comorbidities, chronic kidney disease, and lower creatinine clearance. Median overall survival (OS) for carboplatin plus 5-FU, cisplatin plus 5-FU, and BSC was 8.05 (HR 0.31 [0.23, 0.43] vs. BSC, <i>p</i> < 0.001; HR 1.06 [0.78, 1.44] vs. cisplatin plus 5-FU, <i>p</i> = 0.7), 8.43, and 3.64 months, respectively. No significant OS difference was observed between carboplatin and cisplatin treatments after propensity score matching. Median progression-free survival (PFS) and objective response rates (ORR) showed no significant difference between carboplatin and cisplatin treatments. <b>Conclusions</b>: Despite less favorable baseline characteristics of patients receiving carboplatin plus 5-FU, this combination exhibited comparable OS, PFS, and ORR to cisplatin plus 5-FU in real-world scenarios. Furthermore, it significantly improved OS over BSC. Consequently, carboplatin plus 5-FU should be considered as an alternative regimen, particularly for advanced-stage ESCC patients who are ineligible for cisplatin. |
| first_indexed | 2024-04-24T18:09:07Z |
| format | Article |
| id | doaj.art-5d641bf6a8674d45894f0061d47330c0 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-04-24T18:09:07Z |
| publishDate | 2024-03-01 |
| publisher | MDPI AG |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-5d641bf6a8674d45894f0061d47330c02024-03-27T13:48:10ZengMDPI AGJournal of Clinical Medicine2077-03832024-03-01136173510.3390/jcm13061735Comparing the Efficacy of Carboplatin plus 5-Fluorouracil, Cisplatin plus 5-Fluorouracil, and Best Supportive Care for Advanced Esophageal Squamous Cell Carcinoma: A Propensity Score Analysis from a Tertiary Hospital in Southern ThailandJirapat Wonglhow0Panu Wetwittayakhlang1Patrapim Sunpaweravong2Chirawadee Sathitruangsak3Arunee Dechaphunkul4Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, ThailandDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, ThailandDivision of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, ThailandDivision of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, ThailandDivision of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand<b>Background</b>: Although cisplatin plus 5-fluorouracil (5-FU) is the standard first-line treatment for advanced-stage esophageal squamous cell carcinoma (ESCC), carboplatin was substituted for cisplatin in cisplatin-ineligible patients. The efficacy of carboplatin plus 5-FU for advanced-stage ESCC remains unreported. <b>Methods</b>: This retrospective study analyzed first-line treatment—carboplatin plus 5-FU, cisplatin plus 5-FU, or best supportive care (BSC)—in advanced-stage ESCC patients at a tertiary hospital in Thailand (2012–2022). Survival was assessed using the Kaplan–Meier method, compared via the log-rank test, and adjusted through propensity score matching. Significance was set at <i>p</i> < 0.05. <b>Results</b>: Of 256 patients, 39.9% received carboplatin plus 5-FU, 27.7% cisplatin plus 5-FU, and 32.4% BSC. Carboplatin was significantly associated with older age, poorer performance status, more comorbidities, chronic kidney disease, and lower creatinine clearance. Median overall survival (OS) for carboplatin plus 5-FU, cisplatin plus 5-FU, and BSC was 8.05 (HR 0.31 [0.23, 0.43] vs. BSC, <i>p</i> < 0.001; HR 1.06 [0.78, 1.44] vs. cisplatin plus 5-FU, <i>p</i> = 0.7), 8.43, and 3.64 months, respectively. No significant OS difference was observed between carboplatin and cisplatin treatments after propensity score matching. Median progression-free survival (PFS) and objective response rates (ORR) showed no significant difference between carboplatin and cisplatin treatments. <b>Conclusions</b>: Despite less favorable baseline characteristics of patients receiving carboplatin plus 5-FU, this combination exhibited comparable OS, PFS, and ORR to cisplatin plus 5-FU in real-world scenarios. Furthermore, it significantly improved OS over BSC. Consequently, carboplatin plus 5-FU should be considered as an alternative regimen, particularly for advanced-stage ESCC patients who are ineligible for cisplatin.https://www.mdpi.com/2077-0383/13/6/1735esophageal cancersquamous cell carcinomaadvanced stagechemotherapycarboplatin5-fluorouracil |
| spellingShingle | Jirapat Wonglhow Panu Wetwittayakhlang Patrapim Sunpaweravong Chirawadee Sathitruangsak Arunee Dechaphunkul Comparing the Efficacy of Carboplatin plus 5-Fluorouracil, Cisplatin plus 5-Fluorouracil, and Best Supportive Care for Advanced Esophageal Squamous Cell Carcinoma: A Propensity Score Analysis from a Tertiary Hospital in Southern Thailand Journal of Clinical Medicine esophageal cancer squamous cell carcinoma advanced stage chemotherapy carboplatin 5-fluorouracil |
| title | Comparing the Efficacy of Carboplatin plus 5-Fluorouracil, Cisplatin plus 5-Fluorouracil, and Best Supportive Care for Advanced Esophageal Squamous Cell Carcinoma: A Propensity Score Analysis from a Tertiary Hospital in Southern Thailand |
| title_full | Comparing the Efficacy of Carboplatin plus 5-Fluorouracil, Cisplatin plus 5-Fluorouracil, and Best Supportive Care for Advanced Esophageal Squamous Cell Carcinoma: A Propensity Score Analysis from a Tertiary Hospital in Southern Thailand |
| title_fullStr | Comparing the Efficacy of Carboplatin plus 5-Fluorouracil, Cisplatin plus 5-Fluorouracil, and Best Supportive Care for Advanced Esophageal Squamous Cell Carcinoma: A Propensity Score Analysis from a Tertiary Hospital in Southern Thailand |
| title_full_unstemmed | Comparing the Efficacy of Carboplatin plus 5-Fluorouracil, Cisplatin plus 5-Fluorouracil, and Best Supportive Care for Advanced Esophageal Squamous Cell Carcinoma: A Propensity Score Analysis from a Tertiary Hospital in Southern Thailand |
| title_short | Comparing the Efficacy of Carboplatin plus 5-Fluorouracil, Cisplatin plus 5-Fluorouracil, and Best Supportive Care for Advanced Esophageal Squamous Cell Carcinoma: A Propensity Score Analysis from a Tertiary Hospital in Southern Thailand |
| title_sort | comparing the efficacy of carboplatin plus 5 fluorouracil cisplatin plus 5 fluorouracil and best supportive care for advanced esophageal squamous cell carcinoma a propensity score analysis from a tertiary hospital in southern thailand |
| topic | esophageal cancer squamous cell carcinoma advanced stage chemotherapy carboplatin 5-fluorouracil |
| url | https://www.mdpi.com/2077-0383/13/6/1735 |
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