Department of Surgery, University of Kentucky School of Medicine, Lexington, KY, USA.
Ann Surg Oncol. 2011 Feb;18(2):551-8. doi: 10.1245/s10434-010-1314-7. Epub 2010 Sep 14.
For patients with locally advanced esophageal cancer, prospective randomized clinical trials have reported no added value of surgical resection to chemoradiation alone. Using a large regional cancer registry, our objective was to determine whether curative-intent esophageal resection provided a survival advantage in the multimodality management of esophageal cancer.
Using the Los Angeles County Cancer Surveillance Program (CSP), we identified all patients with local and regional (i.e., AJCC Stages I-III) esophageal cancer during the years 1988-2006. Clinical and pathologic data included patient demographics, tumor information, indication for surgery, lymph node status, and timing of therapy. Overall survival was assessed by the Kaplan-Meier method, and multivariate Cox-regression analysis was performed.
From CSP, 2233 patients with esophageal cancer were identified. Median survival (MS) of the entire cohort was 13.1 months. We stratified this cohort into patients who received chemoradiation alone (n = 645) and patients who received trimodality therapy (n = 286) (i.e., chemoradiation and surgery). Patients had significantly improved survival with trimodality therapy compared with chemoradiation alone (MS 25.2 vs. 12.3 months, respectively; P < 0.001). The survival advantage with trimodality therapy was observed for patients with squamous cell carcinoma (MS 24.5 vs. 12.8 months, respectively; P < 0.001) and adenocarcinoma (MS 25.9 vs. 10.6 months, respectively; P < 0.001). By multivariate analysis, trimodality therapy was a significant prognostic factor for improved survival in patients with esophageal cancer (hazard ratio [HR] 0.66, 95% confidence interval [95% CI]: 0.56-0.77, P < 0.001).
Our data indicate that surgical resection remains an important component of the multimodality management of esophageal cancer.
对于局部晚期食管癌患者，前瞻性随机临床试验报告手术切除联合放化疗并未增加获益。利用大型区域性癌症登记处，我们旨在确定在食管癌的多模式治疗中，根治性食管切除术是否能提供生存优势。
利用洛杉矶县癌症监测计划（CSP），我们确定了 1988 年至 2006 年期间所有局部和区域（即 AJCC 分期 I-III 期）食管癌患者。临床和病理数据包括患者人口统计学、肿瘤信息、手术指征、淋巴结状态和治疗时机。采用 Kaplan-Meier 方法评估总生存期，并进行多变量 Cox 回归分析。
从 CSP 中确定了 2233 例食管癌患者。全队列的中位生存期（MS）为 13.1 个月。我们将该队列分为单纯放化疗组（n=645）和接受三联疗法组（n=286）（即放化疗联合手术）。与单纯放化疗相比，三联疗法组患者的生存显著改善（MS 分别为 25.2 个月和 12.3 个月，P<0.001）。三联疗法在鳞癌患者（MS 分别为 24.5 个月和 12.8 个月，P<0.001）和腺癌患者（MS 分别为 25.9 个月和 10.6 个月，P<0.001）中观察到生存优势。多变量分析表明，三联疗法是食管癌患者生存改善的显著预后因素（风险比 [HR] 0.66，95%置信区间 [95%CI]：0.56-0.77，P<0.001）。
我们的数据表明，手术切除仍然是食管癌多模式治疗的重要组成部分。
