Wang Jingya, Suri Jaipreet S, Allen Pamela K, Liao Zhongxing, Komaki Ritsuko, Ho Linus, Hofstetter Wayne L, Lin Steven H
Departments of *Radiation Oncology †Biostatistics §Thoracic and Cardiovascular Surgery ‡Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Am J Clin Oncol. 2016 Jun;39(3):228-35. doi: 10.1097/COC.0000000000000066.
We reviewed survival outcomes and factors associated with improved outcomes for patients with stage IVB esophageal cancer who received multimodality therapy with initial chemotherapy followed by concurrent chemoradiation (CRT)±surgery.
We retrospectively identified 96 patients with stage IVB esophageal carcinoma (with positive nonregional lymph nodes and/or distant organ metastasis) treated at a single institution with chemotherapy followed by concurrent CRT, with or without surgery. The Cox proportional hazard model was used to test associations between overall survival (OS), disease-free survival (DFS), locoregional relapse, distant metastasis-free survival, and potential predictive factors.
Median patient age at diagnosis was 59 years. The median OS time among all patients was 21.0 months, and 1-, 2-, and 5-year OS rates were 84.4%, 46.8%, and 17.9%, respectively; corresponding DFS time and rates were 8.1 months and 37%, 24.6%, and 24.6%, respectively. On multivariate analysis, factors that predicted improved OS with aggressive multimodal therapy included young age; lack of anorexia, fatigue at diagnosis; distant nodal metastasis without organ metastasis at diagnosis; and radiographic response to initial chemotherapy. A subset of 14 patients who had surgery after chemotherapy and concurrent CRT also had better median OS (not reached vs. 20 mo for 82 patients who did not receive surgery, P=0.001), DFS (14.6 vs. 5.9 mo, P=0.021), and distant metastasis-free survival (26.7 vs. 9.2 mo, P=0.042).
Aggressive local therapy with radiation and potentially surgery after initial palliative chemotherapy can improve prognosis for a select group of patients with stage IVB esophageal cancer.
我们回顾了接受多模式治疗（初始化疗后序贯同步放化疗（CRT）±手术）的IVB期食管癌患者的生存结局以及与改善结局相关的因素。
我们回顾性纳入了96例在单一机构接受治疗的IVB期食管癌患者（非区域淋巴结阳性和/或远处器官转移），这些患者先接受化疗，然后接受同步CRT，部分患者接受了手术。采用Cox比例风险模型来检验总生存（OS）、无病生存（DFS）、局部区域复发、无远处转移生存与潜在预测因素之间的关联。
诊断时患者的中位年龄为59岁。所有患者的中位OS时间为21.0个月，1年、2年和5年OS率分别为84.4%、46.8%和17.9%；相应的DFS时间和率分别为8.1个月和37%、24.6%和24.6%。多因素分析显示，预测积极多模式治疗能改善OS的因素包括年轻；诊断时无厌食、乏力；诊断时远处淋巴结转移但无器官转移；以及对初始化疗的影像学反应。14例在化疗和同步CRT后接受手术的患者亚组的中位OS（未达到 vs. 82例未接受手术患者的20个月，P = 0.001）、DFS（14.6 vs. 5.9个月，P = 0.021）和无远处转移生存（26.7 vs. 9.2个月，P = 0.042）也更好。
初始姑息化疗后采用积极的局部放疗及可能的手术治疗可改善部分IVB期食管癌患者的预后。
