Forshaw M J, Gossage J A, Chrystal K, Cheong K, Harper P G, Mason R C
Department of General Surgery, Guy's and St Thomas' NHS Trust, St Thomas' Hospital, London, UK.
Clin Oncol (R Coll Radiol). 2006 May;18(4):345-50. doi: 10.1016/j.clon.2006.02.008.
Neoadjuvant chemotherapy is used to downstage locally advanced oesophagogastric cancer. This study assessed whether changes in dysphagia and weight correlated with radiological and pathological assessment of response and surgical decision-making.
All patients with locally advanced carcinoma of the lower oesophagus or oesophagogastric junction treated with neoadjuvant ECF (epirubicin, cisplatin, and 5-fluorouracil) chemotherapy from January 2000 to January 2003 were included in this study. Patients were considered to be operable depending upon their chemotherapy response. Weight and swallowing were assessed before and after chemotherapy. Statistical analysis was carried out using ANOVA, unpaired t test and Fisher's exact test.
Seventy-eight patients (male-female ratio: 6.8: 1; median age: 62.2 years; range: 44.1-78.0 years) underwent a median of three cycles (range: 1-7) of neoadjuvant ECF chemotherapy. Forty patients (51%) gained weight, and swallowing improved in 53 patients (68%). Radiological changes (based on computed tomography) were assessed according to WHO criteria: complete response (5%), partial response (27%), stable disease (46%) and progressive disease (15%). Patients whose swallowing improved gained significantly more weight (P < 0.0001). Swallowing (P = 0.0009) was significantly improved in radiological responders but not weight (P = 0.06); when radiological non-responders were separated into stable and progressive disease, patients with progressive disease were identified as failing to gain weight (P = 0.005). Both swallowing (P < 0.0001) and weight gain (P < 0.0001) were better in patients undergoing surgery. The use of changes of weight (P = 0.42) and swallowing (P = 0.61) failed to separate pathological responders from nonresponders in the subset of patients undergoing surgery.
Weight gain and improved swallowing are good but not absolute indicators of radiological response to chemotherapy and patient selection for surgery. However, changes in these variables are not sufficiently sensitive to identify pathological responders from non-responders.
新辅助化疗用于降低局部晚期食管胃癌的分期。本研究评估吞咽困难和体重的变化是否与反应的影像学和病理学评估以及手术决策相关。
纳入2000年1月至2003年1月期间接受新辅助ECF（表柔比星、顺铂和5-氟尿嘧啶）化疗的所有局部晚期下食管癌或食管胃交界癌患者。根据化疗反应判断患者是否可手术。在化疗前后评估体重和吞咽情况。使用方差分析、非配对t检验和Fisher精确检验进行统计分析。
78例患者（男女比例为6.8:1；中位年龄为62.2岁；范围为44.1 - 78.0岁）接受了中位3个周期（范围为1 - 7个周期）的新辅助ECF化疗。40例患者（51%）体重增加，53例患者（68%）吞咽情况改善。根据世界卫生组织标准评估影像学变化（基于计算机断层扫描）：完全缓解（5%）、部分缓解（27%）、疾病稳定（46%）和疾病进展（15%）。吞咽情况改善的患者体重增加明显更多（P < 0.0001）。影像学反应者的吞咽情况显著改善（P = 0.0009），但体重未显著改善（P = 0.06）；当将影像学无反应者分为疾病稳定和疾病进展两组时，疾病进展患者被确定为体重未增加（P = 0.005）。接受手术的患者吞咽情况（P < 0.0001）和体重增加（P < 0.0001）均更好。在接受手术的患者亚组中，体重变化（P = 0.42）和吞咽情况变化（P = 0.61）未能区分病理反应者和无反应者。
体重增加和吞咽情况改善是化疗影像学反应和手术患者选择的良好但非绝对指标。然而，这些变量的变化对区分病理反应者和无反应者不够敏感。
