Department of Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, Germany.
Langenbecks Arch Surg. 2013 Feb;398(2):211-20. doi: 10.1007/s00423-012-1034-5. Epub 2012 Dec 7.
Preoperative treatment is nowadays standard for locally advanced esophagogastric cancer in Europe. Surprisingly, little attention has been paid to nonresponders so far. The aim of our retrospective exploratory study was the comparison of responder, nonresponder, and primary resected patients in respect of outcome considering the tumor entity.
From 2001-2011, 607 patients with locally advanced esophagogastric carcinoma (adenocarcinoma of the esophagogastric junction (AEG), n = 293; squamous cell cancer (SCC), n = 111; gastric cancer, n = 203) after preoperative treatment (n = 281) or primary resection (n = 326) were included. Histopathological response evaluation (Becker criteria) was available for 263.
A total of 76/263 (28.9 %) were responders (<10 % residual tumor). There was an association of response with increased R0 resections (p < 0.001) but also with a higher complication rate (p = 0.008) compared to nonresponse and primary surgery. Mortality was not influenced. Increased R0 resections after response were confirmed in every tumor entity (AEG, p = 0.010; SCC, p = 0.023; gastric cancer, p = 0.006). Median survival was best for responders with 43.5 months [95 % confidence interval (CI), 27.9-59.1], followed by nonresponders with 24.3 months (95 % CI, 21.6-27.0) and primary resected patients with 20.8 months (95 % CI, 17.7-23.9; p = 0.002). AEG (p = 0.012) and gastric cancer (p = 0.017) revealed identical results, but in the subgroup of SCC, the survival of nonresponders (median, 11.6 months; 95 % CI, 6.9-16.3) was even worse than for primary resected patients (median, 23.8 months; 95 % CI, 1.7-46.0; p = 0.012).
The histopathological response rate was low. Generally, nonresponding patients with AEG or gastric cancer seem not to have a disadvantage compared to primary resected patients, but nonresponders with SCC have a worse prognosis, which strengthens the demand for a critical patient selection in surgery for this tumor entity.
术前治疗目前已成为欧洲局部晚期食管胃交界癌的标准治疗方法。令人惊讶的是，目前对于无应答者关注甚少。本回顾性探索性研究的目的是比较肿瘤实体方面，应答者、无应答者和初次切除患者的预后。
2001 年至 2011 年间，共纳入 607 例局部晚期食管胃交界癌（腺癌，n=293；鳞癌，n=111；胃癌，n=203）患者，这些患者均接受过术前治疗（n=281）或初次手术（n=326）。263 例患者的组织病理学反应评估（Becker 标准）可用。
共有 76/263（28.9%）患者为应答者（残余肿瘤<10%）。与无应答和初次手术相比，应答与更高的 R0 切除率（p<0.001）相关，同时也与更高的并发症发生率（p=0.008）相关。死亡率不受影响。在每种肿瘤实体中，应答后增加 R0 切除率的情况均得到证实（AEG，p=0.010；SCC，p=0.023；胃癌，p=0.006）。应答者的中位总生存时间最佳，为 43.5 个月[95%置信区间（CI），27.9-59.1]，其次是无应答者，为 24.3 个月[95%CI，21.6-27.0]，初次切除患者为 20.8 个月[95%CI，17.7-23.9；p=0.002]。AEG（p=0.012）和胃癌（p=0.017）结果相同，但在 SCC 亚组中，无应答者的生存时间（中位值 11.6 个月；95%CI，6.9-16.3）甚至比初次切除患者更差（中位值 23.8 个月；95%CI，1.7-46.0；p=0.012）。
组织病理学反应率较低。一般来说，AEG 或胃癌的无应答患者与初次切除患者相比似乎没有劣势，但 SCC 的无应答患者预后更差，这加强了对该肿瘤实体进行严格患者选择的需求。
