Matsuda Satoru, Tsubosa Yasuhiro, Niihara Masahiro, Sato Hiroshi, Takebayashi Katsushi, Kawamorita Keisuke, Mori Keita, Tsushima Takahiro, Yokota Tomoya, Ogawa Hirofumi, Onozawa Yusuke, Yasui Hirofumi, Takeuchi Hiroya, Kitagawa Yuko
Division of Esophageal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
Ann Surg Oncol. 2015;22(6):1866-73. doi: 10.1245/s10434-014-4337-7. Epub 2015 Jan 7.
The oncological outcomes of transthoracic esophagectomy (TTE) and definitive chemoradiotherapy (dCRT) as initial treatment in patients with esophageal squamous cell carcinoma (ESCC) who could tolerate TTE remains unclear.
Consecutive patients histologically diagnosed with stage I/II/III ESCC (excluding cT4 or cN3) or stage IV ESCC due to supraclavicular lymph node metastasis were eligible for inclusion in this retrospective study. To select patients who could tolerate TTE, respiratory function, Eastern Cooperative Oncology Group performance status, and preoperative complications were considered. Patient characteristics, recurrence-free survival (RFS), 3- and 5-year overall survival (OS), pattern of recurrence, and treatments after initial treatment failure were investigated.
Overall, 112 patients were included in the TTE group and 65 were included in the dCRT group. No significant differences were observed in patient characteristics and clinical stage between the TTE and dCRT groups (stage I/II/III/IV of 29/27/46/10 in the TTE group and 23/15/20/7 in the dCRT group). The R0 resection rate was 87 % in the TTE group, and complete response rate was 68 % in the dCRT group. In intention-to-treat analysis, there was no significant difference in RFS. In contrast, 3-year OS of non-stage IA patients was significantly longer in the TTE group than the dCRT group (TTE 66.9 %; dCRT 49.8 %; p = 0.023). In non-stage IA patients, after initial treatment failure significantly more patients could undergo local treatment (radiotherapy or surgery in the TTE group; surgery or endoscopic resection or photodynamic therapy in the dCRT group) in the TTE group than the dCRT group (TTE 74 %; dCRT 40 %; p = 0.003).
In locally advanced ESCC patients who could tolerate TTE, TTE extended 3-year OS, which might have been encouraged by utilizing local treatment after initial treatment failure.
对于能够耐受经胸段食管癌切除术（TTE）的食管鳞状细胞癌（ESCC）患者，TTE与根治性放化疗（dCRT）作为初始治疗的肿瘤学结局尚不清楚。
组织学诊断为I/II/III期ESCC（不包括cT4或cN3）或因锁骨上淋巴结转移导致的IV期ESCC的连续患者有资格纳入本回顾性研究。为选择能够耐受TTE的患者，考虑了呼吸功能、东部肿瘤协作组体能状态和术前并发症。调查了患者特征、无复发生存期（RFS）、3年和5年总生存期（OS）、复发模式以及初始治疗失败后的治疗情况。
总体而言，TTE组纳入112例患者，dCRT组纳入65例患者。TTE组和dCRT组之间在患者特征和临床分期方面未观察到显著差异（TTE组I/II/III/IV期分别为29/27/46/10例，dCRT组为23/15/20/7例）。TTE组的R0切除率为87%，dCRT组的完全缓解率为68%。在意向性分析中，RFS无显著差异。相比之下，非IA期患者的TTE组3年OS显著长于dCRT组（TTE组66.9%；dCRT组49.8%；p = 0.023）。在非IA期患者中，初始治疗失败后，TTE组能够接受局部治疗（TTE组为放疗或手术；dCRT组为手术或内镜切除或光动力疗法）的患者明显多于dCRT组（TTE组74%；dCRT组40%；p = 0.003）。
在能够耐受TTE的局部晚期ESCC患者中，TTE延长了3年OS，这可能是由于在初始治疗失败后采用局部治疗所致。
