Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan.
Ann Surg Oncol. 2012 Jul;19(7):2169-77. doi: 10.1245/s10434-012-2223-8.
Esophagectomy remains the mainstay treatment for clinical T1bN0M0 esophageal cancer because pathologic lymph node metastases in these patients are not negligible. Recently, chemoradiotherapy (CRT), which can preserve the esophagus, has been reported to be a promising therapeutic alternative to esophagectomy. However, to our knowledge, no comparative studies of esophagectomy and CRT have been reported in clinical T1bN0M0 esophageal cancer.
A total of 173 patients with clinical T1bN0M0 squamous cell carcinoma of the thoracic esophagus were enrolled in this study, 102 of whom were treated with radical esophagectomy (S group) and 71 with definitive CRT (CRT group). Treatment results of both groups were retrospectively compared.
No statistically significant difference was found in overall survival, but the S group displayed significantly better progression-free survival than the CRT group. Disease recurrence was observed in 12 S group patients and 20 CRT group patients. The incidence of distant recurrence was similar, while local recurrence and lymph node recurrence were significantly more frequent in the CRT group. In the S group, 20 patients had pathologic lymph node metastasis. The progression-free survival of patients with pathologic lymph node metastasis did not differ from those without nodal metastasis. In the CRT group, local recurrence could be controlled by salvage esophagectomy, but treatment results of lymph node recurrence were poor; only 4 of 12 patients with lymph node recurrences were cured.
Selection of patients at high risk of pathologic lymph node metastasis is essential when formulating treatment decisions for clinical T1bN0M0 esophageal cancers.
食管癌切除术仍然是临床 T1bN0M0 食管癌的主要治疗方法，因为这些患者的病理淋巴结转移不容忽视。最近，能够保留食管的放化疗（CRT）已被报道为食管癌切除术的一种有前途的治疗选择。然而，据我们所知，在临床 T1bN0M0 食管癌中，尚未报道食管癌切除术和 CRT 的比较研究。
本研究共纳入 173 例临床 T1bN0M0 胸段食管鳞状细胞癌患者，其中 102 例行根治性食管癌切除术（S 组），71 例行确定性 CRT（CRT 组）。回顾性比较两组的治疗结果。
总生存率无统计学差异，但 S 组无进展生存率明显优于 CRT 组。S 组 12 例和 CRT 组 20 例患者出现疾病复发。远处复发的发生率相似，但 CRT 组局部复发和淋巴结复发的发生率明显更高。在 S 组中，20 例患者有病理淋巴结转移。有病理淋巴结转移的患者的无进展生存率与无淋巴结转移的患者无差异。在 CRT 组中，局部复发可以通过挽救性食管切除术控制，但淋巴结复发的治疗效果较差；12 例淋巴结复发患者中仅有 4 例治愈。
在制定临床 T1bN0M0 食管癌的治疗决策时，选择有病理淋巴结转移高危风险的患者至关重要。
