Javle M M, Nwogu C E, Donohue K A, Iyer R V, Brady W E, Khemka S V, Smith J L, Demmy T L, Yang G Y, Nava H R
Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
Dis Esophagus. 2006;19(2):78-83. doi: 10.1111/j.1442-2050.2006.00544.x.
Therapeutic options for locoregional esophageal cancer (EC) include primary surgery, neoadjuvant or definitive chemoradiation and systemic chemotherapy. The role of surgery in these multimodal strategies has recently been debated and definitive chemoradiation is being offered as an alternative to surgery at many centers. We examined our results with multimodal therapy and surgery in this patient population. We conducted a retrospective analysis of 172 patients with locoregional (AJCC stages I-III) EC treated at RPCI between February 14, 1990 and September 20, 2002. Median age was 65 years (range, 36-95); there were 136 male patients. There were 100 regional (stages IIB-III), 69 local (stages I-IIA) and three in situ cases. Initial therapy was either combined modality (n = 122) or single modality (surgery) (n = 50). There was 0%, 30-day, postoperative mortality. Median survival for all patients was 25.3 months and was better for local stage with surgery alone (75 months) than with neoadjuvant (35.7 months) or definitive chemoradiation (19.1 months, P < 0.001). Survival for patients with regional disease treated with surgery alone, neoadjuvant or definitive chemoradiation was 21.5, 24.4 and 11.8 months, respectively (P = not significant). The associations of prognostic factors with overall survival were evaluated using Cox proportional hazards regression analysis and 2-sided Wald's chi-square test. On multivariate analysis, carefully selected patients treated with surgery alone had better outcomes compared with those treated with definitive chemoradiation (P < 0.001). Patients with locoregional esophageal cancer who are eligible for surgical resection either alone or as a part of multimodal therapy may have better outcomes than those treated with non-surgical approaches.
局部区域性食管癌（EC）的治疗选择包括原发性手术、新辅助或根治性放化疗以及全身化疗。手术在这些多模式治疗策略中的作用最近存在争议，在许多中心，根治性放化疗正被作为手术的替代方案。我们在此患者群体中研究了多模式治疗和手术的结果。我们对1990年2月14日至2002年9月20日期间在罗斯韦帕克癌症中心（RPCI）接受治疗的172例局部区域性（美国癌症联合委员会（AJCC）I - III期）EC患者进行了回顾性分析。中位年龄为65岁（范围36 - 95岁）；男性患者有136例。有100例区域性（IIB - III期）、69例局部性（I - IIA期）和3例原位癌病例。初始治疗为联合治疗（n = 122）或单一治疗（手术）（n = 50）。术后30天死亡率为0%。所有患者的中位生存期为25.3个月，单纯手术治疗局部期患者的生存期（75个月）优于新辅助治疗（35.7个月）或根治性放化疗（19.1个月，P < 0.001）。单纯手术、新辅助治疗或根治性放化疗的区域性疾病患者的生存期分别为21.5、24.4和11.8个月（P = 无显著性差异）。使用Cox比例风险回归分析和双侧Wald卡方检验评估预后因素与总生存期的相关性。多因素分析显示，与接受根治性放化疗的患者相比，精心挑选的单纯手术治疗患者预后更好（P < 0.001）。适合单独手术切除或作为多模式治疗一部分的局部区域性食管癌患者可能比接受非手术治疗的患者预后更好。
