Toxopeus E L A, Talman S, van der Gaast A, Spaander V M C W, van Rij C M, Krak N C, Biermann K, Tilanus H W, Mathijssen R H J, van Lanschot J J B, Wijnhoven B P L
Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Eur J Surg Oncol. 2015 Mar;41(3):323-32. doi: 10.1016/j.ejso.2014.11.043. Epub 2014 Dec 3.
Patients with locoregionally advanced oesophageal tumours or disputable distant metastases are referred for induction chemotherapy with the aim to downstage the tumour before an oesophagectomy is considered.
Patients who underwent induction chemotherapy between January 2005 and December 2012 were identified from an institutional database. Treatment plan was discussed in the multidisciplinary team. Response to chemotherapy was assessed by CT. Survival was calculated using the Kaplan Meier method. Uni- and multivariable analyses were performed to identify prognostic factors for survival.
In total 124 patients received induction chemotherapy mainly for locoregionally advanced disease (n = 80). Surgery was withheld in 35 patients because of progressive disease (n = 16) and persistent unresectability (n = 19). The median overall survival of this group was 13 months (IQR: 8-19). The remaining 89 patients underwent surgery of which 13 still had unresectable tumour or distant metastases. Of the 76 patients that underwent an oesophagectomy, 50 patients had tumour free resection margins (66%) with an estimated 5-year survival of 37%. A positive resection margin (HR 4.148, 95% CI 2.298-7.488, p < 0.0001) was associated with a worse survival in univariable analysis, but only pathological lymph node status with increasing hazard ratio's (6.283-10.283, p = 0.001) remained significant after multivariable analysis.
Induction chemotherapy downstages the tumour and facilitates a radical oesophagectomy in patients with advanced oesophageal cancer. Pathological lymph node status is an independent prognostic factor for overall survival.
局部区域晚期食管癌患者或有可疑远处转移的患者会接受诱导化疗，目的是在考虑进行食管切除术之前使肿瘤降期。
从机构数据库中识别出2005年1月至2012年12月期间接受诱导化疗的患者。在多学科团队中讨论治疗方案。通过CT评估化疗反应。使用Kaplan Meier方法计算生存率。进行单变量和多变量分析以确定生存的预后因素。
共有124例患者接受诱导化疗，主要用于局部区域晚期疾病（n = 80）。35例患者因疾病进展（n = 16）和持续不可切除（n = 19）而未进行手术。该组的中位总生存期为13个月（IQR：8 - 19）。其余89例患者接受了手术，其中13例仍有不可切除的肿瘤或远处转移。在接受食管切除术的76例患者中，50例患者的切缘无肿瘤（66%），估计5年生存率为37%。在单变量分析中，切缘阳性（HR 4.148，95% CI 2.298 - 7.488，p < 0.0001）与较差的生存率相关，但在多变量分析后，只有病理淋巴结状态的风险比增加（6.283 - 10.283，p = 0.001）仍然显著。
诱导化疗可使肿瘤降期，并有助于晚期食管癌患者进行根治性食管切除术。病理淋巴结状态是总生存的独立预后因素。
