Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Int J Radiat Oncol Biol Phys. 2011 Jul 15;80(4):996-1001. doi: 10.1016/j.ijrobp.2010.03.003. Epub 2010 Jun 30.
To better define the benefit of a pathologic complete response (pCR) after neoadjuvant chemoradiotherapy in the treatment of esophageal and gastroesophageal cancer, we undertook a comprehensive review of the literature to derive a pooled analysis of crude survival data and quantify the survival benefit of pCR vs. residual disease at esophagectomy.
In all, 22 articles were reviewed. Crude overall survival data, stratified by patients with pCR vs. those with residual disease at esophagectomy, were collected and analyzed using a chi-square analysis. The relative and absolute survival benefit of achieving a pCR were calculated and analyzed. Finally, stratified median survival times were also analyzed.
Overall survival for patients with pCR was 93.1%, 75.0%, and 50.0% at 2, 3, and 5 years, respectively, whereas it was 36.8%, 29.0%, and 22.6% for patients with residual tumor (p < 0.025). The mean relative survival benefit of pCR at 2, 3, and 5 years was 2.05, 2.35, and 2.84, respectively. The mean absolute survival benefit of pCR was 35.66%, 33.79%, and 33.20%, respectively. Median survival times for patients with pCR were significantly longer than for those with residual tumor (p = 0.011).
In esophageal and gastroesophageal cancers, pCR seems to significantly increase overall survival in patients undergoing neoadjuvant chemoradiotherapy. Specifically, the data suggest that patients with pCR are two to three times more likely to survive than are those with residual tumor at esophagectomy. Moreover, these data suggest that 33-36% more patients survive when pCR is achieved than when it is not.
为了更好地定义新辅助放化疗治疗食管和胃食管交界处癌后病理完全缓解（pCR）的获益，我们对文献进行了全面回顾，对原始生存数据进行了荟萃分析，并量化了 pCR 与食管切除术后残留疾病相比的生存获益。
共回顾了 22 篇文章。收集并分析了 pCR 患者与食管切除术后残留疾病患者的原始总生存率数据，并采用卡方分析进行分层。计算并分析了实现 pCR 的相对和绝对生存获益。最后，还分析了分层的中位生存时间。
pCR 患者的 2 年、3 年和 5 年总生存率分别为 93.1%、75.0%和 50.0%，而残留肿瘤患者的生存率分别为 36.8%、29.0%和 22.6%（p<0.025）。pCR 在 2 年、3 年和 5 年的平均相对生存获益分别为 2.05、2.35 和 2.84。pCR 的平均绝对生存获益分别为 35.66%、33.79%和 33.20%。pCR 患者的中位生存时间明显长于残留肿瘤患者（p=0.011）。
在食管和胃食管交界处癌中，pCR 似乎显著提高了接受新辅助放化疗的患者的总生存率。具体而言，数据表明，pCR 患者的生存率比食管切除术后残留肿瘤患者高 2 至 3 倍。此外，这些数据表明，实现 pCR 可使生存率提高 33-36%。
