Dresner S M, Griffin S M
Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Br J Surg. 2000 Oct;87(10):1426-33. doi: 10.1046/j.1365-2168.2000.01541.x.
Despite increasingly radical surgery for oesophageal cancer, many patients continue to develop recurrent disease. The aim of this study was to evaluate the pattern of failure following attempted curative oesophagectomy with two-field lymphadenectomy for adenocarcinoma and squamous cell carcinoma of the middle and lower third of the oesophagus.
A total of 176 consecutive patients discharged from hospital following R0 resection between 1 April 1990 and 31 December 1999 were followed for evidence of recurrence over a mean interval of 26 months.
Adenocarcinoma was the predominant histological subtype (n = 113) compared with squamous cell carcinoma (n = 63). Sex and age distribution were similar for both histological subtypes (M:F ratio 2.5:1, median age 64 (range 40-77) years). Overall 2- and 5-year survival rates were 54 and 31 per cent respectively. Some 85 patients (48 per cent) developed proven recurrence, of whom five are alive and 80 dead. The median time to recurrence was 11.7 (range 1. 5-67) months, with a median survival thereafter of only 2.7 (0-25.9) months. The pattern of recurrence was locoregional in 27 per cent (mediastinal 21 per cent and cervical 6 per cent) and distant in 18 per cent (liver 6 per cent, bone 6 per cent, cerebral 2 per cent, peritoneal 2 per cent, lung 1 per cent, skin 1 per cent). There was no difference in the overall pattern of dissemination or timing of recurrence for either histological subtype. Over 50 per cent of all recurrences occurred within 12 months of surgery, with local, regional and distant recurrence occurring at a median of 11.9 (range 1.8-52), 11.0 (range 5-67) and 11.0 (1.5-58) months respectively.
The low incidence of cervical recurrence suggests that a more extensive 'three-field' lymphadenectomy is unlikely to improve survival rates. Better staging modalities are needed to identify patients who will have recurrence within 12 months of operation, so that they may be either entered into trials of multimodality treatment or offered non-surgical palliation. British Journal of Surgery prize-winning paper, presented to the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, London, UK, September 1999
尽管食管癌手术方式越来越激进，但许多患者仍会出现疾病复发。本研究的目的是评估对食管中下段腺癌和鳞癌行根治性食管切除术加两野淋巴结清扫术后的失败模式。
1990年4月1日至1999年12月31日期间共有176例连续行R0切除术后出院的患者，平均随访26个月以观察复发证据。
腺癌是主要的组织学亚型（n = 113），鳞癌为63例。两种组织学亚型的性别和年龄分布相似（男：女比例为2.5：1，中位年龄64岁（范围40 - 77岁））。总体2年和5年生存率分别为54%和31%。约85例患者（48%）出现确诊复发，其中5例存活，80例死亡。复发的中位时间为11.7个月（范围1.5 - 67个月），此后的中位生存期仅为2.7个月（0 - 25.9个月）。复发模式为局部区域复发占27%（纵隔21%，颈部6%），远处复发占18%（肝脏6%，骨6%，脑2%，腹膜2%，肺1%，皮肤1%）。两种组织学亚型在总体播散模式或复发时间方面无差异。超过50%的复发发生在术后12个月内，局部、区域和远处复发的中位时间分别为11.9个月（范围1.8 - 52个月）、11.0个月（范围5 - 67个月）和11.0个月（1.5 - 58个月）。
颈部复发发生率低表明更广泛的“三野”淋巴结清扫不太可能提高生存率。需要更好的分期方法来识别术后12个月内会复发的患者，以便他们能够参加多模式治疗试验或接受非手术姑息治疗。英国外科杂志获奖论文，于1999年9月在英国伦敦提交给英国和爱尔兰上消化道外科医生协会
