Department of Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan.
J Gastroenterol Hepatol. 2012 Apr;27 Suppl 3:88-94. doi: 10.1111/j.1440-1746.2012.07078.x.
The most effective treatment would be neoadjuvant chemoradiotherapy (NACRT) plus surgery with three-field lymphadenectomy, if tolerability and complications are acceptable. The aim of this prospective study was to evaluate the tolerability of NACRT+ systematic three-field lymphadenectomy.
A total of 127 cases of advanced esophageal carcinoma were objected, among which 32 had NACRT, being the cases suspected to cT3-T4 or, < cT3 with multiple lymph node metastasis. ≥ T2 of 95 cases were treated by surgery alone (NACRT [-] case). The effect of NACRT was evaluated by histological examination and corrected with the clinicopathologic factors, including postoperative prognosis. After reports JCOG9907, we treated eight cases with neoadjuvant chemotherapy at stages II and III. We examined Musashi-1 staining for these eight cases.
Histological good response to NACRT group showed good prognosis. Lymph node metastasis is a predictive factor for prognosis. In this additional study, Musashi-1 was positive after neoadjuvant chemotherapy in three cases. The histological response was grade 1 in all of them and recurrence was observed within a short period of time. Two cases of grade 3 were negative staining to Musashi-1 and showed no recurrence.
This study shows that NACRT plus surgery with three-field lymphadenectomy is a feasible therapeutic approach for the cases with multiple lymph node metastases. Prognosis was significantly better in cases with marked histological improvement. It is important to find the predictive factors of histological improvement. Musashi-1 might be a candidate maker for histological response and prognosis, and further studies are needed to prove it.
如果耐受和并发症可接受，最有效的治疗方法将是新辅助放化疗（NACRT）加三野淋巴结清扫术。本前瞻性研究旨在评估 NACRT+系统三野淋巴结清扫术的耐受性。
共纳入 127 例晚期食管癌患者，其中 32 例接受 NACRT，为 cT3-T4 或<cT3 伴多发淋巴结转移患者。95 例≥T2 患者仅接受手术治疗（NACRT[-]例）。通过组织学检查和术后预后等临床病理因素对 NACRT 效果进行评估。在 JCOG9907 报告后，我们对 8 例Ⅱ、Ⅲ期患者进行了新辅助化疗。我们对这 8 例患者进行了 Musashi-1 染色检查。
NACRT 组组织学反应良好的患者预后良好。淋巴结转移是预后的预测因素。在这项附加研究中，3 例新辅助化疗后 Musashi-1 阳性。它们的组织学反应均为 1 级，且在短时间内复发。2 例 Musashi-1 染色阴性的 3 级患者无复发。
本研究表明，对于淋巴结转移多发的患者，NACRT 加三野淋巴结清扫术是一种可行的治疗方法。组织学改善明显的患者预后显著更好。寻找组织学改善的预测因素很重要。Musashi-1 可能是组织学反应和预后的候选标志物，需要进一步研究来证明。
