Watanabe Masayuki, Baba Yoshifumi, Yoshida Naoya, Ishimoto Takatsugu, Nagai Yohei, Iwatsuki Masaaki, Iwagami Shiro, Baba Hideo
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan,
Ann Surg Oncol. 2014 Sep;21(9):2838-44. doi: 10.1245/s10434-014-3684-8. Epub 2014 Apr 9.
There is a consensus that neoadjuvant therapy is an essential component of treatment for resectable advanced esophageal cancer. The aim of this study was to evaluate the efficacy of preoperative docetaxel/cisplatin/5-fluorouracil (DCF) followed by esophagectomy for patients with node-positive esophageal cancer using a prospective database.
Fifty-five consecutive patients with resectable node-positive esophageal cancer were treated with preoperative DCF between August 2008 and December 2010. Of these patients, 54 completed 2 courses of DCF, and 50 underwent esophagectomy after the planned chemotherapy. Clinical and pathologic responses to DCF were investigated, as was patient prognosis. Cox proportional hazard regression was used to determine factors that independently affected recurrence.
Complete response, partial response, stable disease, and progressive disease were observed in 5, 24, 24, and 2 patients, respectively. Overall, the clinical response rate was 53 %. Pathologic complete response was achieved in 6 cases (12 %), and the overall pathologic response rate was 36 %. Downstaging was observed in 23 cases (46 %). Two-year overall and disease-free survival rates were 78 and 56 %, respectively. Multivariate analysis revealed that residual tumor [R1/2; hazard ratio (HR) 5.21, 95 % confidence interval (CI) 1.64-17.2], pathologic poor response (grade 1a; HR 3.08, 95 % CI 1.08-11.1), and ypN (M1Lym; HR 13.3, 95 % CI 2.06-116) were independent predictors of recurrence.
DCF has strong antitumor activity for esophageal cancer and may confer survival benefits when used as preoperative chemotherapy.
新辅助治疗是可切除的进展期食管癌治疗的重要组成部分，这一点已达成共识。本研究旨在利用前瞻性数据库评估术前多西他赛/顺铂/5-氟尿嘧啶（DCF）方案联合食管切除术治疗淋巴结阳性食管癌患者的疗效。
2008年8月至2010年12月期间，连续55例可切除的淋巴结阳性食管癌患者接受了术前DCF方案治疗。其中，54例患者完成了2个疗程的DCF治疗，50例患者在计划化疗后接受了食管切除术。研究了DCF的临床和病理反应以及患者预后。采用Cox比例风险回归分析确定独立影响复发的因素。
分别有5例、24例、24例和2例患者出现完全缓解、部分缓解、病情稳定和病情进展。总体而言，临床缓解率为53%。6例（12%）患者达到病理完全缓解，总体病理缓解率为36%。23例（46%）患者出现降期。两年总生存率和无病生存率分别为78%和56%。多因素分析显示，残留肿瘤[R1/2；风险比（HR）5.21，95%置信区间（CI）1.64 - 17.2]、病理反应不佳（1a级；HR 3.08，95%CI 1.08 - 11.1）和ypN（M1Lym；HR 13.3，95%CI 2.06 - 116）是复发的独立预测因素。
DCF对食管癌具有较强的抗肿瘤活性，作为术前化疗可能带来生存获益。
