Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
Oncology. 2012;83(5):300-4. doi: 10.1159/000341353. Epub 2012 Sep 4.
For patients with localized esophageal cancer (EC) who can withstand surgery, the preferred therapy is chemoradiation followed by surgery (trimodality). However, after achieving a clinical complete response [clinCR; defined as both post-chemoradiation endoscopic biopsy showing no cancer and physiologic uptake by positron emission tomography (PET)], some patients decline surgery. The literature on the outcome of such patients is sparse.
Between 2002 and 2011, we identified 622 trimodality-eligible EC patients in our prospectively maintained databases. All patients had to be trimodality eligible and must have completed preoperative staging after chemoradiation that included repeat endoscopic biopsy and PET among other routine tests.
Out of 622 trimodality-eligible patients identified, 61 patients (9.8%) declined surgery. All 61 patients had a clinCR. The median age was 69 years (range 47-85). Males (85.2%) and Caucasians (88.5%) were dominant. Baseline stage was II (44.2%) or III (52.5%), and histology was adenocarcinoma (65.6%) or squamous cell carcinoma (29.5%). Forty-two patients are alive at a median follow-up of 50.9 months (95% CI 39.5-62.3). The 5-year overall and relapse-free survival rates were 58.1 ± 8.4 and 35.3 ± 7.6%, respectively. Of 13 patients with local recurrence during surveillance, 12 had successful salvage resection.
Although the outcome of 61 EC patients with clinCR who declined surgery appears reasonable, in the absence of a validated prediction/prognosis model, surgery must be encouraged for all trimodality-eligible patients.
对于能够承受手术的局限性食管癌（EC）患者，首选治疗方法是放化疗后手术（三联疗法）。然而，在达到临床完全缓解（clinCR；定义为放化疗后内镜活检无癌和正电子发射断层扫描（PET）的生理摄取）后，一些患者拒绝手术。关于此类患者的预后文献很少。
在 2002 年至 2011 年间，我们从我们前瞻性维护的数据库中确定了 622 名符合三联疗法条件的 EC 患者。所有患者都必须符合三联疗法条件，并在放化疗后完成术前分期，包括重复内镜活检和 PET 等常规检查。
在确定的 622 名符合三联疗法条件的患者中，有 61 名（9.8%）拒绝手术。所有 61 名患者均达到 clinCR。中位年龄为 69 岁（范围 47-85）。男性（85.2%）和白种人（88.5%）居多。基线期为 II 期（44.2%）或 III 期（52.5%），组织学为腺癌（65.6%）或鳞状细胞癌（29.5%）。42 名患者在中位随访 50.9 个月（95%CI 39.5-62.3）时仍存活。5 年总生存率和无复发生存率分别为 58.1±8.4%和 35.3±7.6%。在随访期间有 13 名患者局部复发，其中 12 名患者成功接受了挽救性切除。
尽管 61 名clinCR 且拒绝手术的 EC 患者的预后似乎合理，但在缺乏经过验证的预测/预后模型的情况下，必须鼓励所有符合三联疗法条件的患者进行手术。
