Department of Medical Oncology and Hematology, Kliniken Essen-Mitte, Essen, Germany.
Eur J Cancer. 2012 Nov;48(16):2977-82. doi: 10.1016/j.ejca.2012.03.010. Epub 2012 Apr 11.
Due to the poor prognosis of locally advanced oesophageal cancer, predictive markers are warranted to better select patients who may benefit from multimodal therapy.
Patients with oesophageal cancer from two multicentric prospective trials were selected for having received radiochemotherapy followed by macroscopic complete tumour resection. Several pretreatment and treatment related factors were retrospectively analysed for their ability to serve as predictive markers.
Overall 107 patients with squamous cell carcinomas stage T3-4 N and M0 were included in the analysis. All of them had complete preoperative radiochemotherapy. Microscopic (n=96) or macroscopic (N=11) complete resection was achieved by transthoracic oesophagectomy. The median follow-up time exceeded 6 years. Local progression free and overall survival were significantly hampered in patients with residual tumour in their resected specimen (n=76) compared with patients who showed a pathohistologic complete tumour remission (n=31) (overall survival rate at 3 years 25.2% versus 65.6%; hazard ratio (HR)=3.50 (95%-confidence interval (CI) 1.91-6.44); p<0.0001). A multivariable analysis proved both resection status and pathohistologic results to be independent acting predictive factors for local progression free and overall survival after preoperative radiochemotherapy with surgery.
From our study it appears that the pathohistologic results can be a valuable surrogate marker for predicting long term survival and local tumour control in patients with locally advanced squamous cell carcinoma (SCC) of the oesophagus after preoperative radiochemotherapy and surgery. Moreover, even after intensive preoperative therapy a complete tumour resection seems to be an important precondition for long term survival.
由于局部晚期食管癌预后较差，因此需要预测标志物，以便更好地选择可能从多模态治疗中获益的患者。
从两个多中心前瞻性试验中选择患有食管癌的患者，这些患者接受了放化疗，然后进行了宏观完全肿瘤切除术。回顾性分析了几种治疗前和治疗相关因素，以评估其作为预测标志物的能力。
总共纳入了 107 名 T3-4N 和 M0 期的鳞状细胞癌患者进行分析。所有患者均接受了完整的术前放化疗。通过经胸食管切除术实现了微观（n=96）或宏观（N=11）完全切除。中位随访时间超过 6 年。与病理完全肿瘤消退（n=31）的患者相比，在切除标本中仍有肿瘤残留（n=76）的患者局部无进展生存期和总生存期明显较差（3 年总生存率为 25.2%比 65.6%；危险比（HR）=3.50（95%置信区间（CI）为 1.91-6.44）；p<0.0001）。多变量分析证实，手术前放化疗后的局部无进展生存期和总生存期的独立预测因素为切除状态和病理结果。
从我们的研究中可以看出，病理结果可以作为预测接受术前放化疗和手术的局部晚期食管鳞状细胞癌（SCC）患者长期生存和局部肿瘤控制的有价值的替代标志物。此外，即使经过强化的术前治疗，完全肿瘤切除似乎也是长期生存的重要前提。
