Hironaka Shuichi, Ohtsu Atsushi, Boku Narikazu, Muto Manabu, Nagashima Fumio, Saito Hiroki, Yoshida Shigeaki, Nishimura Mitsuyo, Haruno Masatora, Ishikura Satoshi, Ogino Takashi, Yamamoto Seiichiro, Ochiai Atsushi
Division of Digestive Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Int J Radiat Oncol Biol Phys. 2003 Oct 1;57(2):425-33. doi: 10.1016/s0360-3016(03)00585-6.
To compare the treatment results between radical surgery and definitive chemoradiotherapy for resectable squamous cell carcinoma of the esophagus and to identify useful clinicopathologic and biologic markers to select better treatment.
Between August 1992 and April 1999, 98 consecutive patients were selected for this study; 53 were treated with chemoradiotherapy and 45 with surgery. The patients in the chemoradiotherapy group received 5-fluorouracil combined with cisplatin plus 60 Gy of radiation, and those in the surgery group received an esophagectomy with radical node dissection. Biologic markers were investigated immunohistochemically using pretreatment biopsy specimens.
The baseline clinical TNM stage was more advanced in the chemoradiotherapy group than in the surgery group. With a median follow-up period of 43 months, the 5-year survival rate was 46% in the chemoradiotherapy and 51% in the surgery group, without statistical significance (p = 0.47, log-rank test). Cox regression analysis for prognosis revealed that epidermal growth factor receptor positivity, high microvessel density, and cyclin D1 positivity yielded a low value for relative risk (0.66, 0.54, and 0.62, respectively), which favored chemoradiotherapy over surgery, without statistical significance.
This nonrandomized study showed a trend for the chemoradiotherapy in the treatment of esophageal carcinoma, but the results need to be confirmed by additional study.
比较根治性手术与根治性放化疗治疗可切除食管鳞状细胞癌的疗效，并确定有助于选择更佳治疗方案的临床病理及生物学标志物。
1992年8月至1999年4月，连续选取98例患者纳入本研究；53例接受放化疗，45例接受手术治疗。放化疗组患者接受5-氟尿嘧啶联合顺铂加60 Gy放疗，手术组患者接受食管切除术及根治性淋巴结清扫术。使用治疗前活检标本通过免疫组织化学方法研究生物学标志物。
放化疗组的基线临床TNM分期比手术组更晚。中位随访期为43个月，放化疗组的5年生存率为46%，手术组为51%，无统计学差异（p = 0.47，对数秩检验）。预后的Cox回归分析显示，表皮生长因子受体阳性、高微血管密度和细胞周期蛋白D1阳性的相对风险值较低（分别为0.66、0.54和0.62），这表明放化疗优于手术，但无统计学意义。
这项非随机研究显示放化疗在食管癌治疗中有一定趋势，但结果需进一步研究证实。
