Elias D, Lasser P, Mankarios H, Cabanes P A, Escudier B, Kac J, Rougier P
Oncologic Digestive Surgery Department, Institut Gustave-Roussy, Villejuif, France.
Eur J Surg Oncol. 1992 Dec;18(6):563-71.
From 1982 to 1990, 181 patients underwent surgery for esophageal squamous cell carcinoma, for which 14 prognostic parameters were prospectively recorded in order to perform a multivariate study. A squamous cell head and neck cancer was associated with the esophageal tumor in 40% of the cases (synchronous 18% and metachronous 22%). Resection was curative (i.e. macroscopically complete) in 128 cases, palliative (i.e. with residual tumor) in 24 cases and not possible in 29 cases. There were 21 deaths in hospital (hospital mortality was 11.7%). One hundred and twenty-two patients received preoperative chemotherapy and 77 received postoperative radiotherapy according to different phase II prospective studies. The 5-year survival rate according to the Kaplan-Meier method was 15.8% (+/- 3.4) for all patients and 23.5% (+/- 4.8) for the patients who had a curative resection. A palliative resection or the invasion of a neighbouring organ was synonymous with incurability, but positive lymph nodes were not considered proof of incurability. The multifactorial study concerning all the patients highlighted two main prognostic parameters: the histological staging according to the Japanese classification (P = 0.0006) and the type of resection (curative or not) (P = 0.006). An objective response to preoperative chemotherapy was the third and last parameter revealed by Cox's model. The multivariate study, which was limited to the 112 patients who were alive after a curative resection, showed that only the stage was an important prognostic factor (P = 0.003), with stages 2 and 3 carrying a worse prognosis. We propose a therapeutic scheme, based on these prognostic data and on the usual pre-therapeutic workup with three additional exams: CT scan measurement of tumor diameter, ultrasound examination +/- fine needle aspiration cytology of supra-clavicular lymph nodes and echo-endoscopy. The aim of this scheme is to limit surgery to the subgroup of patients for whom this modality is really beneficial.
1982年至1990年期间，181例患者接受了食管鳞状细胞癌手术，前瞻性记录了14个预后参数以进行多因素研究。40%的病例中，食管肿瘤伴有头颈部鳞状细胞癌（同时性18%，异时性22%）。128例切除为根治性（即宏观上完整），24例为姑息性（即有残留肿瘤），29例无法切除。21例患者住院死亡（医院死亡率为11.7%）。根据不同的II期前瞻性研究，122例患者接受了术前化疗，77例患者接受了术后放疗。根据Kaplan-Meier法，所有患者的5年生存率为15.8%（±3.4），根治性切除患者的5年生存率为23.5%（±4.8）。姑息性切除或侵犯邻近器官意味着无法治愈，但阳性淋巴结不被视为无法治愈的证据。针对所有患者的多因素研究突出了两个主要预后参数：根据日本分类法的组织学分期（P = 0.0006）和切除类型（根治性或非根治性）（P = 0.006）。对术前化疗的客观反应是Cox模型揭示的第三个也是最后一个参数。限于112例根治性切除后存活患者的多因素研究表明，只有分期是重要的预后因素（P = 0.003），2期和3期预后较差。基于这些预后数据以及常规治疗前检查并增加三项额外检查，我们提出了一种治疗方案：CT扫描测量肿瘤直径、超声检查±锁骨上淋巴结细针穿刺细胞学检查和超声内镜检查。该方案的目的是将手术限制在真正受益的患者亚组中。
