新辅助放化疗和手术治疗食管癌后病理完全缓解患者的复发模式。

Recurrence pattern in patients with a pathologically complete response after neoadjuvant chemoradiotherapy and surgery for oesophageal cancer.

机构信息

Department of Surgery, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands.

出版信息

Br J Surg. 2013 Jan;100(2):267-73. doi: 10.1002/bjs.8968. Epub 2012 Nov 23.

DOI:10.1002/bjs.8968

PMID:23180560

Abstract

BACKGROUND

Little is known about recurrence patterns in patients with a pathologically complete response (pCR) or an incomplete response after neoadjuvant chemoradiotherapy (CRT) followed by resection for oesophageal cancer. This study was performed to determine the pattern of recurrence in patients with a pCR after neoadjuvant CRT followed by surgery.

METHODS

All patients who received neoadjuvant CRT followed by oesophagectomy between 1993 and 2009 were identified from a database, and categorized according to pathological tumour response. Recurrences were classified as locoregional or distant.

RESULTS

One hundred and eighty-eight patients were included. Median potential follow-up was 71·6 months. A pCR was achieved in 62 (33·0 per cent) of 188 patients. Recurrence developed in 24 (39 per cent) of 62 patients with a pCR and 70 (55·6 per cent) of 126 without a pCR (P = 0·044). Locoregional recurrence with or without synchronous distant metastases occurred in eight patients (13 per cent) in the pCR group and 31 (24·6 per cent) in the non-pCR group (P = 0·095). Locoregional recurrences without synchronous distant metastases occurred four (6 per cent) and ten (7·9 per cent) patients respectively (P = 0·945). The overall 5-year survival rate was significantly higher in the pCR group than in the non-pCR group (52 versus 33·9 per cent respectively; P = 0·019).

CONCLUSION

Of patients with a pCR, 13 per cent still developed a locoregional recurrence. Although pCR is more favourable for survival, it is not synonymous with cure or complete locoregional disease control.

摘要

背景

接受新辅助放化疗（CRT）后行切除术的食管癌患者，病理完全缓解（pCR）或不完全缓解后的复发模式知之甚少。本研究旨在确定新辅助 CRT 后手术治疗 pCR 患者的复发模式。

方法

从数据库中确定了 1993 年至 2009 年间接受新辅助 CRT 后行食管癌切除术的所有患者，并根据病理肿瘤反应进行分类。复发分为局部区域或远处。

结果

共纳入 188 例患者。中位潜在随访时间为 71.6 个月。188 例患者中 62 例（33.0%）达到 pCR。62 例 pCR 患者中有 24 例（39.0%）发生复发，126 例非 pCR 患者中有 70 例（55.6%）发生复发（P = 0.044）。pCR 组中有 8 例（13.0%）出现局部区域复发伴或不伴同步远处转移，非 pCR 组中有 31 例（24.6%）出现（P = 0.095）。pCR 组中局部区域无同步远处转移的复发分别为 4 例（6.0%）和 10 例（7.9%）（P = 0.945）。pCR 组的 5 年总生存率明显高于非 pCR 组（分别为 52%和 33.9%；P = 0.019）。