Dijon University Hospital, France.
Claude-Huriez University Hospital, Lille, France.
Eur J Cancer. 2015 Sep;51(13):1683-93. doi: 10.1016/j.ejca.2015.05.027. Epub 2015 Jul 7.
Two randomised trials concerning thoracic oesophageal cancer concluded that for squamous cell carcinoma, chemoradiation alone leads to the same overall survival (OS) as chemoradiation followed by surgery. One of these trials, FFCD 9102, randomised only fit, compliant and operable responders to induction chemoradiation between continuation of chemoradiation and surgery. In the present analysis, the outcome in the patients not eligible for randomisation was calculated to determine if attempt of surgery should be recommended.
Eligible patients had operable T3-N0/N1-M0 thoracic oesophageal cancer. After initial chemoradiation, patients with no clinical response, or with contraindication to follow any attributed treatment, were not randomised. OS was studied first in the whole population of not randomised patients, and then specifically in clinical non-responders. The impact of surgery on OS was studied in these two populations.
Of the 451 registered patients in the trial, 192 were not randomised. Among them, 111 were clinical non-responders. Median OS was significantly shorter for non-randomised patients (11.5 months) than for randomised patients (18.9 months; p=0.0024). However, for the 112 non-randomised patients who underwent surgery, median OS was not different from that in randomised patients: 17.3 versus 18.9 months (p=0.58). Concerning clinical non-responders, median OS was longer for those who underwent surgery compared to non-operated patients: 17.0 versus 5.5 months (hazard ratio (HR)=0.39 [0.25-0.61]; p<0.0001), and again was not different from that in responding, randomised patients (p=0.40).
In patients with locally advanced thoracic oesophageal cancer, overall survival did not differ between responders to induction chemoradiation and patients having surgery after clinical failure of chemoradiation. Surgery should therefore be considered in those patients who are still operable.
两项关于胸段食管鳞癌的随机试验得出结论，对于食管鳞癌，单纯放化疗与放化疗后手术的总生存期（OS）相同。其中一项试验 FFCD 9102 仅对接受诱导放化疗的适合、依从性好和可手术的患者随机分组，继续放化疗或手术。在本分析中，计算了不符合随机分组条件的患者的结局，以确定是否应建议尝试手术。
纳入标准为可手术的 T3-N0/N1-M0 胸段食管鳞癌患者。初始放化疗后，无临床反应或对任何归因治疗有禁忌证的患者不进行随机分组。首先在未随机分组患者的总体人群中研究 OS，然后专门在临床无反应者中研究 OS。在这两个人群中研究手术对 OS 的影响。
在该试验中登记的 451 例患者中，有 192 例未随机分组。其中，111 例为临床无反应者。未随机分组患者的中位 OS 明显短于随机分组患者（11.5 个月比 18.9 个月；p=0.0024）。然而，对于 112 例接受手术的未随机分组患者，中位 OS 与随机分组患者无差异：17.3 个月比 18.9 个月（p=0.58）。对于临床无反应者，接受手术的患者的中位 OS 长于未手术的患者：17.0 个月比 5.5 个月（风险比（HR）=0.39[0.25-0.61]；p<0.0001），与有反应的随机分组患者的 OS 无差异（p=0.40）。
在局部晚期胸段食管鳞癌患者中，诱导放化疗有反应者与放化疗后临床失败行手术者的总生存期无差异。因此，对于那些仍可手术的患者，应考虑手术。
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