Stiles Brendon M, Salzler Gregory G, Nasar Abu, Paul Subroto, Lee Paul C, Port Jeffrey L, Altorki Nasser K
Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
Eur J Cardiothorac Surg. 2015 Sep;48(3):455-60; discussion 460-1. doi: 10.1093/ejcts/ezu479. Epub 2015 Jan 5.
Although oesophagectomy can be curative for patients with oesophageal cancer (OC), it may be associated with high morbidity and decreased quality of life. Identifying risk factors for early systemic progression or death after oesophagectomy may help to guide treatment choices in at-risk patients.
Patients undergoing oesophagectomy following neoadjuvant therapy for OC (November 1987 to January 2013) were reviewed, excluding deaths ≤3 months. Univariate predictors of death ≤1 year of operation were explored by logistic regression. Significant predictors (P ≤ 0.10) were included in a multivariate model. A risk factor index was created based on the number of significant risk factors in individual patients.
Of 581 patients, 238 had neoadjuvant chemotherapy or chemotherapy and radiation followed by oesophagectomy. Of these, 15% (n = 36) died ≤1 year following oesophagectomy and 69% of those from documented cancer recurrence. Clinical predictors of death ≤1 year by multivariate analysis included performance status >0 (HR 2.19; CI 1.02-4.69), poor (G3) tumour differentiation (HR 2.67; CI 1.14-6.21) and lack of clinical response (no response or progression versus complete and partial response) to neoadjuvant therapy (HR 2.77; CI 1.07-7.15). For patients with all factors evaluable (n = 167), variables were summed to derive a cumulative risk factor index, 0-3. An increased risk factor index (≥2) was highly associated with increased risk of death ≤1 year postoperatively (HR 4.84; CI 1.93-12.16), as well as with poor overall survival.
Clinically defined risk factors that predict early mortality following oesophagectomy include performance status, poor tumour differentiation and clinical response. In patients with at least two of these risk factors, 29% will die within 1 year of surgery. These patients should be identified and individual consideration given to less morbid surgical strategies or to alternative treatments.
尽管食管癌切除术对食管癌（OC）患者可能具有治愈效果，但它可能与高发病率及生活质量下降相关。识别食管癌切除术后早期全身进展或死亡的风险因素，可能有助于指导高危患者的治疗选择。
回顾1987年11月至2013年1月期间接受新辅助治疗后行食管癌切除术的患者，排除术后≤3个月死亡的患者。通过逻辑回归分析探索术后≤1年死亡的单因素预测指标。将具有显著意义的预测指标（P≤0.10）纳入多因素模型。根据个体患者显著风险因素的数量创建一个风险因素指数。
581例患者中，238例接受了新辅助化疗或化疗联合放疗后行食管癌切除术。其中，15%（n = 36）在食管癌切除术后≤1年死亡，且69%死于记录在案的癌症复发。多因素分析显示，术后≤1年死亡的临床预测指标包括体能状态＞0（HR 2.19；CI 1.02 - 4.69）、肿瘤低分化（G3）（HR 2.67；CI 1.14 - 6.21）以及对新辅助治疗无临床反应（无反应或进展与完全缓解和部分缓解相比）（HR 2.77；CI 1.07 - 7.15）。对于所有因素均可评估的患者（n = 167），将各变量相加得出累积风险因素指数，范围为0至3。风险因素指数增加（≥2）与术后≤1年死亡风险增加（HR 4.84；CI 1.93 - 12.16）以及总体生存率较差高度相关。
预测食管癌切除术后早期死亡的临床确定风险因素包括体能状态、肿瘤低分化和临床反应。在具有至少两种这些风险因素的患者中，29%将在手术1年内死亡。应识别出这些患者，并对手术创伤较小的手术策略或替代治疗进行个体化考虑。
