Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
J Gastrointest Surg. 2013 Aug;17(8):1359-69. doi: 10.1007/s11605-013-2223-4. Epub 2013 May 29.
Experience with neoadjuvant chemoradiation (CXRT) has raised questions regarding the additional benefit of surgery after locally advanced esophageal adenocarcinoma patients achieve a clinical response to CXRT. We sought to quantify the value of surgery by comparing the overall (OS) and disease-free survival (DFS) of trimodality-eligible patients treated with definitive CXRT vs. CXRT followed by esophagectomy.
We identified 143 clinical stage III esophageal adenocarcinoma patients that were eligible for trimodality therapy. All patients successfully completed neoadjuvant CXRT and were considered appropriate candidates for resection. Patients that were medically inoperable were excluded. Cox regression models were used to identify significant predictors of survival.
Among the 143 patients eligible for surgery after completing CXRT, 114 underwent resection and 29 did not. Poorly differentiated tumors (HR = 2.041, 95% CI = 1.235-3.373) and surgical resection (HR = 0.504, 95% CI = 0.283-0.899) were the only independent predictors of OS. Patients treated with surgery had a 50 and 54 % risk reduction in overall and cancer-specific mortality, respectively. Median OS (41.2 vs. 20.3 months, p = 0.012) and DFS (21.5 vs. 11.4 months, p = 0.007) were significantly improved with the addition of surgery compared to definitive CXRT.
Surgery provides a significant survival benefit to trimodality-eligible esophageal adenocarcinoma patients with locally advanced disease.
新辅助放化疗（CXRT）的经验引发了一些疑问，即对于局部晚期食管腺癌患者在对 CXRT 产生临床反应后，手术是否能带来额外获益。我们旨在通过比较接受根治性 CXRT 与 CXRT 后行切除术的局部晚期食管腺癌患者的总生存期（OS）和无病生存期（DFS），来量化手术的价值。
我们确定了 143 例符合三联疗法条件的临床 III 期食管腺癌患者。所有患者均成功完成新辅助 CXRT，且被认为适合进行手术切除。排除因身体原因无法手术的患者。采用 Cox 回归模型确定生存的显著预测因素。
在完成 CXRT 后有手术适应证的 143 例患者中，114 例行切除术，29 例未行切除术。低分化肿瘤（HR=2.041，95%CI=1.235-3.373）和手术切除（HR=0.504，95%CI=0.283-0.899）是 OS 的唯一独立预测因素。接受手术治疗的患者，其全因和癌症特异性死亡率分别降低了 50%和 54%。与根治性 CXRT 相比，加用手术可显著改善 OS（41.2 个月与 20.3 个月，p=0.012）和 DFS（21.5 个月与 11.4 个月，p=0.007）。
手术为局部晚期食管腺癌患者提供了显著的生存获益，这些患者符合三联疗法条件。
