Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
Ann Surg Oncol. 2012 Feb;19(2):357-64. doi: 10.1245/s10434-011-1945-3. Epub 2011 Jul 20.
Consensus guidelines recommend neoadjuvant therapy in locally advanced esophageal cancer; however, whether this recommendation has been widely adopted is unknown. Therefore, we evaluated the utilization of neoadjuvant therapy in esophageal cancer and its association with outcomes in the United States.
From the National Cancer Data Base all patients with middle and lower third clinical stage I-III esophageal cancers who underwent surgical resection were identified (1998-2007). Multivariable regression models were developed to identify predictors of neoadjuvant therapy use and associated outcomes.
We identified 8562 patients who underwent surgical resection for esophageal cancer. In nonmetastatic locally advanced tumors, neoadjuvant therapy use increased (stage II 47.9% to 72.5%; stage III 51.0% to 90.1%; P < 0.001). On multivariable analysis, factors associated with the decreased use of neoadjuvant therapy for stage II and III disease were age ≥75 years, Medicare insurance coverage, Charlson score ≥2, stage II (vs. III) disease, and geographic region. Patients with stage II and III disease who underwent neoadjuvant therapy had a lower risk of positive lymph nodes (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.35-0.55) and positive surgical margins (OR 0.51, 95% CI 0.38-0.69). Thirty-day postoperative mortality rates were not significantly affected by neoadjuvant therapy (OR 0.90, 95% CI 0.66-1.24). A pathologic complete response was observed in 10.8% of patients. The only factor that was predictive of pathologic complete response was squamous cell tumor histology (OR 2.14, 95% CI 1.52-3.02).
In surgically treated patients, the use of neoadjuvant trimodal therapy has increased in the past decade; however, opportunities exist to improve adherence to national guidelines.
共识指南建议对局部晚期食管癌进行新辅助治疗；然而，尚不清楚这一建议是否得到了广泛采纳。因此，我们评估了新辅助治疗在食管癌中的应用及其与美国患者结局的关系。
从国家癌症数据库中确定了所有接受手术切除的中下段临床 I-III 期食管癌患者（1998-2007 年）。采用多变量回归模型确定新辅助治疗使用的预测因素及其相关结局。
我们共确定了 8562 例接受手术治疗的食管癌患者。在非转移性局部晚期肿瘤中，新辅助治疗的应用有所增加（II 期 47.9%增至 72.5%；III 期 51.0%增至 90.1%；P<0.001）。多变量分析显示，II 期和 III 期疾病新辅助治疗使用率降低的相关因素包括年龄≥75 岁、医疗保险覆盖、Charlson 评分≥2、II 期（而非 III 期）疾病以及地理位置。接受新辅助治疗的 II 期和 III 期疾病患者的阳性淋巴结（比值比[OR]0.45，95%置信区间[CI]0.35-0.55）和阳性手术切缘（OR 0.51，95%CI 0.38-0.69）的风险较低。新辅助治疗对 30 天术后死亡率没有显著影响（OR 0.90，95%CI 0.66-1.24）。10.8%的患者观察到病理完全缓解。唯一可预测病理完全缓解的因素是鳞状细胞肿瘤组织学（OR 2.14，95%CI 1.52-3.02）。
在接受手术治疗的患者中，过去十年新辅助三联疗法的应用有所增加；然而，仍有机会提高对国家指南的依从性。
