Division of Thoracic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
Ann Thorac Surg. 2012 Nov;94(5):1659-66. doi: 10.1016/j.athoracsur.2012.05.044. Epub 2012 Sep 13.
Neoadjuvant chemoradiation followed by surgery (NeoCRT) has been advocated as standard therapy for resectable esophageal cancer. Our objective was to compare oncologic outcomes between NeoCRT and upfront surgical resection (SURG).
We conducted a single-institution, retrospective review of all potentially resectable esophageal cancer patients treated with NeoCRT or SURG.
From 2003 to 2010, 151 patients had NeoCRT (n = 48; 31.8%) or SURG (n = 103; 68.1%). Histology was mostly adenocarcinoma (77.5%) or squamous carcinoma (19.2%). Mean radiation dose was 44 ± 0.1 Gy, and 80.8% received platinum-based doublet chemotherapy. There were more women in the SURG group (23.3% vs 4.2%; p < 0.01) and more cardiovascular comorbidity in the NeoCRT group (39.6% vs 21.4%; p = 0.027). There was no difference in age, histology, R0 resection rate, and treatment-related mortality (NeoCRT = 4.2%; SURG = 3.9%; p = 0.15). Failure to undergo resection after NeoCRT (n = 11; 22.9%) was mainly due to disease progression (n = 6) or treatment-related mortality (n = 4). Resection could not be performed in 4 SURG patients (3.9%; p < 0.001; unresectable = 2; occult metastases = 2). NeoCRT did not improve median survival (NeoCRT = 29 ± 6; SURG = 26 ± 3 months; p = 0.376) or recurrence-free interval (NeoCRT = 25.8 ± 5; SURG = 19.4 ± 2 months; p = 0.19). Complete pathologic response (n = 8; 21.6%) was not associated with improved survival. If we exclude from analysis NeoCRT patients who did not undergo surgery, survival was significantly improved after NeoCRT (NeoCRT = 41 ± 15; SURG = 24 ± 8 months; p = 0.0082).
Patient selection and early assessment of treatment response may be key factors in identifying the best candidates for trimodality therapy.
新辅助放化疗后再手术（NeoCRT）已被推荐为可切除食管癌的标准治疗方法。我们的目的是比较 NeoCRT 和直接手术切除（SURG）的肿瘤学结果。
我们对所有接受 NeoCRT 或 SURG 治疗的潜在可切除食管癌患者进行了单机构回顾性研究。
2003 年至 2010 年，151 例患者接受 NeoCRT（n=48；31.8%）或 SURG（n=103；68.1%）治疗。组织学主要为腺癌（77.5%）或鳞状细胞癌（19.2%）。平均放射剂量为 44±0.1Gy，80.8%接受铂类双联化疗。SURG 组女性更多（23.3% vs 4.2%；p<0.01），NeoCRT 组心血管合并症更多（39.6% vs 21.4%；p=0.027）。两组年龄、组织学、R0 切除率和治疗相关死亡率无差异（NeoCRT=4.2%；SURG=3.9%；p=0.15）。NeoCRT 后未能行切除术（n=11；22.9%）主要因疾病进展（n=6）或治疗相关死亡（n=4）。4 例 SURG 患者（3.9%；p<0.001；不可切除=2；隐匿性转移=2）无法行切除术。NeoCRT 并未改善中位生存期（NeoCRT=29±6；SURG=26±3 个月；p=0.376）或无复发生存期（NeoCRT=25.8±5；SURG=19.4±2 个月；p=0.19）。完全病理缓解（n=8；21.6%）与生存改善无关。如果我们排除未行手术的 NeoCRT 患者进行分析，NeoCRT 后生存显著改善（NeoCRT=41±15；SURG=24±8 个月；p=0.0082）。
患者选择和治疗反应的早期评估可能是确定最佳三联疗法候选者的关键因素。
