新辅助放化疗反应者、无反应者以及接受局部晚期食管鳞状细胞癌原发切除术患者的生存比较：新辅助放化疗对所有患者都有益吗？
Comparison of survival among neoadjuvant chemoradiation responders, non-responders and patients receiving primary resection for locally advanced oesophageal squamous cell carcinoma: does neoadjuvant chemoradiation benefit all?
作者信息
Hsu Po-Kuei, Chien Ling-I, Huang Chien-Sheng, Hsieh Chih-Cheng, Wu Yu-Chung, Hsu Wen-Hu, Chou Teh-Ying
机构信息
Department of Surgery, Division of Thoracic Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
出版信息
Interact Cardiovasc Thorac Surg. 2013 Sep;17(3):460-6. doi: 10.1093/icvts/ivt216. Epub 2013 May 31.
OBJECTIVES
While neoadjuvant chemoradiation followed by surgery has been shown to improve the survival of patients with locally advanced oesophageal cancer, it is not known whether neoadjuvant chemoradiation has a beneficial or harmful effect on the non-responders. We aimed to compare the outcomes among neoadjuvant chemoradiation responders, non-responders and patients receiving primary oesophagectomies for resectable locally advanced oesophageal squamous cell carcinoma.
METHODS
Eighty-four non-T1-2N0 oesophageal squamous cell carcinoma patients were included. Thirty-eight patients received primary resection and 46 patients received neoadjuvant chemoradiation. The overall survival of chemoradiation responders (<50% residual tumour), non-responders (>50% residual tumour and those who shifted to definitive chemoradiation instead of surgery due to tumour progression) and patients receiving primary resection were compared. Clinical parameters were also compared between responders and non-responders.
RESULTS
There was no overall difference in survival between neoadjuvant chemoradiation and primary resection groups (2-year overall survival rates: 45.6 vs 54.3%, P = 0.442). In patients receiving neoadjuvant chemoradiation followed by surgery, pathological responders had significantly higher 2-year overall survival rates than non-responders (64.5 vs 38.9%, P = 0.043). While the pathological responders had the highest survival rate, clinicopathological non-responders (pathological non-responders and patients with tumour progression during the neoadjuvant chemoradiation period) demonstrated significantly worse outcomes than those receiving primary resection (32.0 vs 54.3%, P = 0.036). However, none of the clinical parameters, including blood profiles, images and baseline tumour characteristics, predicted the response to chemoradiation before treatment.
CONCLUSIONS
Neoadjuvant chemoradiation non-responders demonstrated no benefit and an even worse outcome compared with those receiving primary resection for locally advanced oesophageal squamous cell carcinoma. However, no significant clinical parameters could be implemented in the clinics to predict the response to neoadjuvant chemoradiation before treatment.
目的
虽然新辅助放化疗后手术已被证明可提高局部晚期食管癌患者的生存率，但新辅助放化疗对无反应者是有益还是有害尚不清楚。我们旨在比较新辅助放化疗有反应者、无反应者以及接受原发性食管切除术的可切除局部晚期食管鳞状细胞癌患者的预后。
方法
纳入84例非T1-2N0食管鳞状细胞癌患者。38例患者接受了原发性切除术，46例患者接受了新辅助放化疗。比较了放化疗有反应者（残留肿瘤<50%）、无反应者（残留肿瘤>50%以及因肿瘤进展而改为确定性放化疗而非手术的患者）和接受原发性切除术患者的总生存期。还比较了有反应者和无反应者之间的临床参数。
结果
新辅助放化疗组和原发性切除组的生存率无总体差异（2年总生存率：45.6%对54.3%，P = 0.442）。在接受新辅助放化疗后手术的患者中，病理反应者的2年总生存率显著高于无反应者（64.5%对38.9%，P = 0.043）。虽然病理反应者的生存率最高，但临床病理无反应者（病理无反应者和新辅助放化疗期间肿瘤进展的患者）的预后明显比接受原发性切除术的患者差（32.0%对54.3%，P = 0.036）。然而，包括血液指标、影像学和基线肿瘤特征在内的所有临床参数在治疗前均无法预测对放化疗的反应。
结论
对于局部晚期食管鳞状细胞癌，新辅助放化疗无反应者与接受原发性切除术的患者相比没有获益，甚至预后更差。然而，临床上没有显著的临床参数可用于预测治疗前对新辅助放化疗的反应。
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