Chao Yin-Kai, Wu Yi-Cheng, Liu Yun-Hen, Tseng Chen-Kan, Chang Hsien-Kun, Hsieh Ming-Ju, Chu Yen, Liu Hui-Ping
Graduate Institute of Clinical Medical Sciences, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
J Surg Oncol. 2010 Aug 1;102(2):158-62. doi: 10.1002/jso.21588.
Non-regional lymph node metastasis in intrathoracic esophageal cancer is classified as M1 lesion with poor prognosis following surgery alone. We studied the controversial question of whether chemoradiotherapy (CRT) improves survival of these patients.
A cohort of patients with clinically overt nodal M1 disease, which could be encompassed by a tolerable radiation therapy port, was selected from the database of the Chang Gung Memorial Hospital.
From 1994 to 2005, 54 nodal stage IV intrathoracic esophageal squamous cell carcinoma (SCC) patients received neoadjuvant CRT. Significant response occurred in 24 patients. Scheduled esophagectomy was performed in 26 patients. The 3-year overall survival (OS) and disease-free survival (DFS) for the whole group were 27% (median: 14.2 months) and 22% (median: 14.7 months), respectively. Multivariate analysis identified pretherapy lymph nodes classified as M1a and R0 resection after CRT as independent favorable prognosticators. Median survival reached 36.9 months in the pretherapy M1a subgroup as opposed to 12.5 months in the M1b subgroup (3-year-DFS: 40% vs. 10%, P = 0.0117). Scheduled surgery after CRT benefits only after R0 resection (3-year-DFS: 36%, median survival: 45 months). The group with incomplete resection had a high surgical risk and dismal survival compared to the non-surgery group (3-year-DFS: 0% vs. 9%, 9.5 vs. 10.5 months).
Pretherapy M1a disease had a significantly better survival than nodal M1b disease after CRT in SCC. Aggressive surgical treatment after CRT is reserved for cases when complete resection is anticipated.
胸段食管癌的非区域性淋巴结转移被归类为M1期病变，单纯手术后预后较差。我们研究了放化疗（CRT）是否能改善这些患者生存率这一存在争议的问题。
从长庚纪念医院数据库中选取一组临床明显存在淋巴结M1期病变且可被可耐受放疗野覆盖的患者。
1994年至2005年，54例胸段食管鳞状细胞癌（SCC）伴淋巴结IV期患者接受了新辅助CRT。24例患者出现显著反应。26例患者按计划进行了食管切除术。全组的3年总生存率（OS）和无病生存率（DFS）分别为27%（中位数：14.2个月）和22%（中位数：14.7个月）。多因素分析确定治疗前淋巴结分类为M1a以及CRT后R0切除为独立的有利预后因素。治疗前M1a亚组的中位生存期达到36.9个月，而M1b亚组为12.5个月（3年DFS：40%对10%，P = 0.0117）。CRT后按计划进行手术仅在R0切除后有益（3年DFS：36%，中位生存期：45个月）。与非手术组相比，不完全切除组手术风险高且生存率差（3年DFS：0%对9%，9.5对10.5个月）。
在SCC中，CRT后治疗前M1a期疾病的生存率明显优于淋巴结M1b期疾病。CRT后积极的手术治疗仅适用于预期能完全切除的病例。
