Department of Digestive and Oncologic Surgery, University Hospital Claude Huriez, Centre Hospitalier Régional Universitaire, Lille, France; University of Lille, Nord de France, Lille, France.
Department of Digestive and Oncologic Surgery, University Hospital Claude Huriez, Centre Hospitalier Régional Universitaire, Lille, France; University of Lille, Nord de France, Lille, France; Inserm UMR 837, Jean Pierre Aubert Research Center, Lille, France.
Ann Thorac Surg. 2014 Apr;97(4):1181-9. doi: 10.1016/j.athoracsur.2013.12.026. Epub 2014 Feb 14.
To date, for esophageal cancer (EC), the optimal timing of surgical procedures after neoadjuvant chemoradiation (nCRT) is not well defined. Data in rectal cancer suggest that a prolonged interval between treatment and operation may improve tumoral pathologic response, R0 resection rate, and survival. The aims of this study were to evaluate whether delaying operation after nCRT in EC increases pathologic response and has an impact on oncologic outcome or postoperative course.
A total of 257 consecutive EC patients (n=161 squamous cell carcinomas and n=96 adenocarcinomas) undergoing nCRT followed by operation between 1997 and 2011 were retrospectively analyzed by the use of prospectively collected data. The patients were divided into two groups according to the median delay between nCRT and operation (<7 weeks, n=122; ≥7 weeks, n=135). The impact of surgical delay on outcomes was studied through univariable and multivariable analyses.
The groups were comparable regarding patient and tumor characteristics (p≥0.074). The ypT0 and R0 resection rates were similar between the two groups, as were postoperative course, median survivals, and incidence and patterns of recurrence (p≥0.332). Multivariable analysis failed to identify any impact of the surgical delay on the endpoints. Subgroup analysis according to the histologic type found similar results.
After nCRT for EC, delaying operation does not affect the ypT0 rate, postoperative course, or oncologic outcome and cannot therefore be justified by these aims.
迄今为止，对于食管癌（EC），新辅助放化疗（nCRT）后手术的最佳时机尚未明确。直肠癌的数据表明，治疗和手术之间的时间间隔延长可能会改善肿瘤的病理反应、R0 切除率和生存。本研究旨在评估 nCRT 后延迟手术是否会增加病理反应，并对肿瘤学结果或术后过程产生影响。
回顾性分析了 1997 年至 2011 年间接受 nCRT 后手术的 257 例连续 EC 患者（n=161 例鳞状细胞癌和 n=96 例腺癌），使用前瞻性收集的数据。根据 nCRT 和手术之间的中位延迟时间（<7 周，n=122；≥7 周，n=135）将患者分为两组。通过单变量和多变量分析研究手术延迟对结果的影响。
两组患者的临床病理特征相似（p≥0.074）。两组 ypT0 和 R0 切除率相似，术后过程、中位生存时间以及复发的发生率和模式也相似（p≥0.332）。多变量分析未能确定手术延迟对终点的任何影响。根据组织学类型的亚组分析得出了相似的结果。
在 EC 的 nCRT 后，延迟手术不会影响 ypT0 率、术后过程或肿瘤学结果，因此不能以此为目的。
