Department of Gastrointestinal Medical Oncology.
Ann Oncol. 2013 Nov;24(11):2854-9. doi: 10.1093/annonc/mdt340. Epub 2013 Aug 29.
Patients with localized esophageal adenocarcinoma (EAC) who achieve a clinical complete response (clinCR) after preoperative chemoradiation (trimodality therapy; TMT) or definitive chemoradiation (bimodality therapy; BMT) live longer than those who achieve a <clinCR (Suzuki A, Xiao LC, Hayashi Y et al. Prognostic significance of baseline positron emission tomography and importance of clinical complete response in patients with esophageal or gastroesophageal junction cancer treated with definitive chemoradiotherapy. Cancer 2011; 117: 4823-4833; Cheedella NK, Suzuki A, Xiao L et al. Association between clinical complete response and pathological complete response after preoperative chemoradiation in patients with gastroesophageal cancer: analysis in a large cohort. Ann Oncol 2013; 24: 1262-1266; Ajani JA, Correa AM, Hofstetter WL et al. Clinical parameters model for predicting pathologic complete response following preoperative chemoradiation in patients with esophageal cancer. Ann Oncol 2012; 23: 2638-2642). We hypothesized that the initial standardized uptake value (iSUV) of positron emission tomography will define novel subsets of clinCR patients.
We analyzed 323 EAC patients, from our prospective database, who achieved a clinCR. Various statistical methods were used to assess the influence of iSUV on patient outcome.
The median follow-up of 323 patients was 40.8 months [95% confidence interval (CI) 35.6-47.3 months]. Two hundred six (63.8%) patients had TMT and 117 (36.2%) had BMT. If iSUV was ≥6, TMT patients had a longer median OS (94.8 months; 95% CI 66.07-NA) than BMT patients (31.4 months; 95% CI 21.7-42.1; P ≤ 0.001). However, if iSUV was <6, the median OS of TMT and BMT patients was similar (P = 0.62). iSVU did not influence the pathologic complete response rate in TMT patients (P = 0.85).
clinCR patients with iSUV of <6 are identified as a new subset that fared equally well when treated with TMT or BMT. Future esophageal preservation strategy may be best suited for this newly identified subset of EAC patients.
接受术前放化疗（三联疗法；TMT）或根治性放化疗（双相疗法；BMT）后临床完全缓解（clinCR）的局限性食管腺癌（EAC）患者比未达到 clinCR 的患者存活时间更长（Suzuki A、Xiao LC、Hayashi Y 等人。在接受根治性放化疗的食管癌或胃食管交界处癌患者中，基线正电子发射断层扫描的预后意义和临床完全缓解的重要性。癌症 2011；117:4823-4833；Cheedella NK、Suzuki A、Xiao L 等人。术前放化疗后胃食管癌症患者 clinCR 与病理完全缓解的关系：大队列分析。安肿瘤 2013；24:1262-1266；Ajani JA、Correa AM、Hofstetter WL 等人。食管癌患者术前放化疗后预测病理完全缓解的临床参数模型。安肿瘤 2012；23:2638-2642）。我们假设正电子发射断层扫描的初始标准化摄取值（iSUV）将确定 clinCR 患者的新亚组。
我们分析了我们前瞻性数据库中 323 例达到 clinCR 的 EAC 患者。使用各种统计方法评估 iSUV 对患者预后的影响。
323 例患者的中位随访时间为 40.8 个月[95%置信区间（CI）35.6-47.3 个月]。206 例（63.8%）患者接受 TMT，117 例（36.2%）患者接受 BMT。如果 iSUV≥6，TMT 患者的中位 OS （94.8 个月；95%CI66.07-NA）长于 BMT 患者（31.4 个月；95%CI21.7-42.1；P≤0.001）。然而，如果 iSUV<6，TMT 和 BMT 患者的中位 OS 相似（P=0.62）。iSUV 不影响 TMT 患者的病理完全缓解率（P=0.85）。
iSUV<6 的 clinCR 患者被确定为一个新亚组，与接受 TMT 或 BMT 治疗的患者预后相同。未来的食管保留策略可能最适合这一新确定的 EAC 患者亚组。
