临床Ⅰ期食管鳞癌患者根治性放化疗与手术治疗的对比。

Comparison between definitive chemoradiotherapy and esophagectomy in patients with clinical stage I esophageal squamous cell carcinoma.

机构信息

Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.

出版信息

Am J Gastroenterol. 2011 Jun;106(6):1048-54. doi: 10.1038/ajg.2011.42. Epub 2011 Feb 22.

DOI:10.1038/ajg.2011.42

PMID:21343920

Abstract

OBJECTIVES

Chemoradiotherapy (CRT) has been proposed as an alternative therapy to esophagectomy for esophageal cancer, because of its favorable survival rate and mild toxicity. However, no comparative studies of esophagectomy and CRT have been reported in patients with clinical stage I esophageal squamous cell carcinoma.

METHODS

A total of 54 patients with clinical stage I esophageal squamous cell carcinoma were treated with definitive CRT and 116 patients with esophagectomy at Osaka Medical Center for Cancer and Cardiovascular Diseases between 1995 and 2008, and were included in the analysis. Overall survival and recurrence rates were evaluated.

RESULTS

Complete follow-up data were available for 169 of the 170 patients (99%). The median (range) observation period was 67 (10-171) months in the esophagectomy group and 30 (4-77) months in the CRT group (P<0.0001). The 1- and 3-year overall survival rates were 97.4% and 85.5%, respectively, in the esophagectomy group and 98.1% and 88.7%, respectively, in the CRT group (P=0.78). Cox proportional hazards modeling showed that the overall survival was comparable between the two groups after adjusting for age, sex, and tumor size. The hazard ratio of CRT for overall survival was 0.95 (95% confidence interval 0.37-2.47). The incidence of local recurrence, including metachronous esophageal cancer, was significantly higher in the CRT group than in the esophagectomy group (P<0.0001). Most local recurrences in the CRT group were intramucosal carcinomas, and were cured after salvage treatment, mainly using endoscopy.

CONCLUSIONS

The overall survival rate of patients with clinical stage I esophageal cancer treated with CRT was comparable to that in those treated with esophagectomy, despite a high local recurrence rate. Locally recurrent carcinoma was endoscopically treatable in most patients, with no effect on overall survival. CRT seems to be a viable alternative to esophagectomy in patients with clinical stage I esophageal cancer.

摘要

目的

放化疗（CRT）已被提议作为食管癌的替代疗法，因为它具有良好的生存率和较低的毒性。然而，对于临床 I 期食管鳞状细胞癌患者，尚未有关于手术与 CRT 的比较研究报道。

方法

共有 54 例临床 I 期食管鳞状细胞癌患者于 1995 年至 2008 年在大阪医疗中心癌症和心血管疾病接受根治性 CRT 治疗，116 例患者接受手术治疗，并纳入分析。评估总生存率和复发率。

结果

170 例患者中有 169 例（99%）可获得完整随访数据。手术组的中位（范围）观察期为 67（10-171）个月，CRT 组为 30（4-77）个月（P<0.0001）。手术组 1 年和 3 年的总生存率分别为 97.4%和 85.5%，CRT 组分别为 98.1%和 88.7%（P=0.78）。Cox 比例风险模型显示，在调整年龄、性别和肿瘤大小后，两组的总生存率相当。CRT 组的总体生存率为 0.95（95%置信区间 0.37-2.47）。CRT 组局部复发（包括异时性食管癌）的发生率明显高于手术组（P<0.0001）。CRT 组的大多数局部复发为黏膜内癌，经挽救治疗后，主要采用内镜治疗，可被治愈。