Zacherl Johannes, Sendler Andreas, Stein Hubert J, Ott Katja, Feith Marcus, Jakesz Raimund, Siewert J Rüdiger, Fink Ulrich
Universitätsklinik für Chirurgie, Klinische Abteilung für Allgemeinchirurgie, Allgemeines Krankenhaus der Stadt Wien, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
World J Surg. 2003 Sep;27(9):1067-74. doi: 10.1007/s00268-003-7063-z. Epub 2003 Aug 28.
Prospective studies dealing with preoperative therapy in adenocarcinoma of the esophagus alone are rare. The interpretation of the preferential phase II trials and a few phase III trials is complicated, as most studies include adenocarcinoma of the esophagus (i.e., Barrett's carcinoma), adenocarcinoma of the esophagogastric junction (including cardia carcinoma and subcardia carcinoma), or squamous cell carcinoma. Preoperative chemotherapy, generally well tolerated, cannot decrease the incidence of local failure beyond the level achieved with surgery alone, but it might delay systemic relapse. Preoperative radiotherapy can enhance local control, but it fails to improve overall survival. Neoadjuvant chemoradiation was demonstrated in only one randomized trail to have a survival benefit, but survival in the surgery-alone group was unusually low. Generally, survival was ameliorated in patients responding to neoadjuvant treatment. However, preoperative chemoradiation was often accompanied by a remarkable increase in postoperative morbidity and mortality. Nonresponding patients have, in this respect, a worse prognosis than responders after resection. The prediction of responding patients to neoadjuvant therapy as well as the early identification of patients who will not respond is of utmost clinical importance. Today, there is no absolute evidence that neoadjuvant treatment for patients with potentially resectable Barrett's cancer prolongs survival. In patients with locally advanced, presumably not completely resectable adenocarcinoma of the esophagus, preoperative treatment appears to increase the chance for a curative resection and enhance survival in responding patients. Neoadjuvant treatment of adenocarcinoma of the esophagus, as a consequence, is currently not the standard treatment and should be performed only within controlled clinical trials.
仅针对食管腺癌术前治疗的前瞻性研究很少见。由于大多数研究纳入了食管腺癌（即巴雷特食管癌）、食管胃交界腺癌（包括贲门癌和贲门下癌）或鳞状细胞癌，因此对优先开展的II期试验和少数III期试验的解读较为复杂。术前化疗一般耐受性良好，但无法将局部失败的发生率降低到单纯手术所能达到的水平以下，但可能会延迟全身复发。术前放疗可增强局部控制，但无法提高总体生存率。仅在一项随机试验中证明新辅助放化疗有生存获益，但单纯手术组的生存率异常低。一般来说，对新辅助治疗有反应的患者生存率有所改善。然而，术前放化疗往往伴随着术后发病率和死亡率的显著增加。在这方面，无反应患者切除术后的预后比有反应患者更差。预测患者对新辅助治疗的反应以及早期识别无反应患者具有至关重要的临床意义。目前，尚无绝对证据表明对潜在可切除的巴雷特癌患者进行新辅助治疗可延长生存期。对于局部晚期、可能无法完全切除的食管腺癌患者，术前治疗似乎可增加根治性切除的机会，并提高有反应患者的生存率。因此，食管腺癌的新辅助治疗目前并非标准治疗，仅应在对照临床试验中进行。
