Department of Oncology, Førde Central Hospital, N-6800 Førde, Norway.
World J Surg Oncol. 2010 Jun 1;8:46. doi: 10.1186/1477-7819-8-46.
We aimed to assess whether high-dose preoperative chemoradiotherapy (CRT) improves outcome in esophageal cancer patients compared to surgery alone and to define possible prognostic factors for overall survival.
Hundred-and-seven patients with disease stage IIA - III were treated with either surgery alone (n = 45) or high-dose preoperative CRT (n = 62). The data were collected retrospectively. Sixty-seven patients had adenocarcinomas, 39 squamous cell carcinomas and one undifferentiated carcinoma. CRT was given as three intensive chemotherapy courses by cisplatin 100 mg/m2 on day 1 and 5-fluorouracil 1000 mg/m2/day, from day 1 through day 5 as continuous infusion. One course was given every 21 days. The last two courses were given concurrent with high-dose radiotherapy, 2 Gy/fraction and a median dose of 66 Gy. Kaplan-Meier survival analysis with log rank test was used to obtain survival data and Cox Regression multivariate analysis was used to define prognostic factors for overall survival.
Toxicity grade 3 of CRT occurred in 30 (48.4%) patients and grade 4 in 24 (38.7%) patients of 62 patients. One patient died of neutropenic infection (grade 5). Fifty percent (31 patients) in the CRT group did undergo the planned surgery. Postoperative mortality rate was 9% and 10% in the surgery alone and CRT+ surgery groups, respectively (p = 1.0). Median overall survival was 11.1 and 31.4 months in the surgery alone and CRT+ surgery groups, respectively (log rank test, p = 0.042). In the surgery alone group one, 3 and 5 year survival rates were 44%, 24% and 16%, respectively and in the CRT+ surgery group they were 68%, 44% and 29%, respectively. By multivariate analysis we found that age of patient, performance status, alcoholism and >or= 4 pathological positive lymph nodes in resected specimen were significantly associated with overall survival, whereas high-dose preoperative CRT was not.
We found no significant survival advantage in esophageal cancer stage IIA-III following preoperative high-dose CRT compared to surgery alone. Patient's age, performance status, alcohol abuse and number of positive lymph nodes were prognostic factors for overall survival.
我们旨在评估与单独手术相比，高剂量术前放化疗（CRT）是否能改善食管癌患者的预后，并确定总生存的可能预后因素。
107 例疾病分期为 IIA-III 期的患者分别接受单独手术（n=45）或高剂量术前 CRT（n=62）治疗。数据为回顾性收集。67 例为腺癌，39 例为鳞癌，1 例为未分化癌。CRT 采用顺铂 100mg/m2 于第 1 天和 5-氟尿嘧啶 1000mg/m2/天（第 1 天至第 5 天连续输注）进行 3 个强化化疗疗程。每个疗程 21 天。最后两个疗程与高剂量放疗同时进行，2Gy/分次，中位剂量 66Gy。采用对数秩检验的 Kaplan-Meier 生存分析获取生存数据，采用 Cox 回归多变量分析定义总生存的预后因素。
62 例患者中，30 例（48.4%）出现 CRT 毒性 3 级，24 例（38.7%）出现 4 级。1 例患者因中性粒细胞减少性感染（5 级）死亡。CRT 组中 50%（31 例）患者接受了计划手术。单独手术组和 CRT+手术组的术后死亡率分别为 9%和 10%（p=1.0）。单独手术组和 CRT+手术组的中位总生存期分别为 11.1 和 31.4 个月（对数秩检验，p=0.042）。单独手术组的 1、3 和 5 年生存率分别为 44%、24%和 16%，CRT+手术组分别为 68%、44%和 29%。多变量分析发现，患者年龄、体能状态、酒精滥用和切除标本中阳性淋巴结数≥4 个与总生存显著相关，而高剂量术前 CRT 则不然。
与单独手术相比，我们发现 IIA-III 期食管癌患者接受术前高剂量 CRT 治疗后并无显著生存优势。患者年龄、体能状态、酒精滥用和阳性淋巴结数是总生存的预后因素。
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