Department of Surgery, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
J Gastrointest Surg. 2013 Jul;17(7):1193-201. doi: 10.1007/s11605-013-2212-7. Epub 2013 May 2.
The study was done to determine long-term outcomes of surgically treated esophageal cancer and to identify trends in epidemiology, oncological therapy, and oncological prognosis over the last two decades.
Overall survival in 304 patients undergoing esophagectomy was analyzed. Fifty-three percent had squamous cell carcinoma and 46 % had adenocarcinoma (AC). A total of 161 patients received neoadjuvant chemoradiation, 38 received neoadjuvant chemotherapy, and 105 were treated with surgery alone.
Median survival (MS) increased significantly from 18.0 months (1988-1994) to 26.6 months (1995-2001) and to 59.3 months (2002-2011; p < 0.001). The proportion of AC (22 vs 35 vs 65 %; p < 0.001) and the proportion of patients treated with neoadjuvant therapy (neoT; 15.9 vs 85.3 vs 77.8 %; p < 0.001) increased during the treatment period. After neoT, a beneficial outcome with a MS of 45.6 vs. 20.4 months (p = 0.003) was found. Lymph node ratio [LNR; relative risk (RR), 5.4; p < 0.001], response to neoT (RR, 1.6; p < 0.004), and histological subtype (RR, 1.7; p < 0.003) were identified as independent parameters of survival.
Since 1988, the outcome of surgically resected esophageal cancer strongly improved. Besides tumorbiological factors like histological type and LNR, the outcome is also affected by the increasing use of neoT towards favorable survival rates.
本研究旨在确定接受手术治疗的食管癌患者的长期预后，并确定过去二十年中流行病学、肿瘤治疗和肿瘤预后的趋势。
对 304 例行食管切除术的患者的总生存率进行分析。53%的患者为鳞状细胞癌，46%的患者为腺癌（AC）。共有 161 例患者接受新辅助放化疗，38 例患者接受新辅助化疗，105 例患者仅接受手术治疗。
中位生存期（MS）从 18.0 个月（1988-1994 年）显著增加至 26.6 个月（1995-2001 年）和 59.3 个月（2002-2011 年；p<0.001）。AC 的比例（22%比 35%比 65%；p<0.001）和接受新辅助治疗（neoT）的患者比例（15.9%比 85.3%比 77.8%；p<0.001）在治疗期间增加。接受 neoT 治疗后，MS 为 45.6 个月，优于 20.4 个月（p=0.003）。淋巴结比率[LNR；相对风险（RR），5.4；p<0.001]、neoT 反应（RR，1.6；p<0.004）和组织学亚型（RR，1.7；p<0.003）被确定为生存的独立参数。
自 1988 年以来，手术切除食管癌的预后有了显著改善。除了肿瘤生物学因素如组织学类型和 LNR 外，neoT 的应用增加也对生存结果产生了有利影响。
