*Department of Oncology, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan; †Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; ‡Department of Urology, National Taiwan University College of Medicine, Taipei, Taiwan; §Department of Pathology, ‖Department of Medical Research, ¶Department of Surgery, and #Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; and **Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.
J Thorac Oncol. 2015 Oct;10(10):1481-9. doi: 10.1097/JTO.0000000000000651.
To determine whether the postchemoradiotherapy (post-CRT) pathologic stage predicts the outcomes of patients with locally advanced esophageal squamous cell carcinoma (ESCC) undergoing preoperative CRT followed by surgery.
From three phase II trials of preoperative CRT for locally advanced ESCC, 140 patients were included. Preoperative CRT comprised twice weekly paclitaxel and cisplatin-based regimens and 40-Gy radiotherapy in 20 fractions. The post-CRT pathologic stage was classified according to the American Joint Committee on Cancer, 7th edition staging system. The prognostic effects of clinicopathologic factors were analyzed using Cox regression.
With a median follow-up of 61.9 months, the median progression-free survival (PFS) and overall survival (OS) of the entire cohort were 24.5 and 30.9 months, respectively. The post-CRT pathologic stage was 0 in 34.5%, I in 12.9%, II in 29.3%, III in 13.6%, and ypT0N1-2 in 6.4% of the patients. The median PFS was 47.2, 25.9, 16.0, 9.4, and 15.1 months, and the median OS was 57.4, 34.1, 26.2, 14.1, and 17.6 months for patients with post-CRT pathologic stage 0, I, II, III, and ypT0N1-2, respectively. In multivariate analysis, performance status (p < 0.001), tumor location (p = 0.016), and extranodal extension (p = 0.024) were independent prognostic factors for PFS, whereas performance status (p < 0.001) and post-CRT pathologic stage (p = 0.027) were independent prognostic factors for OS.
The post-CRT pathologic stage classified by American Joint Committee on Cancer, 7th edition staging system predicted the survival of locally advanced ESCC patients who underwent preoperative paclitaxel and cisplatin-based CRT followed by esophagectomy.
本研究旨在探讨放化疗（post-CRT）后病理分期是否能预测接受新辅助放化疗（neoadjuvant concurrent chemoradiotherapy，nCRT）联合手术治疗的局部晚期食管鳞癌（esophageal squamous cell carcinoma，ESCC）患者的预后。
从三阶段 II 期新辅助放化疗治疗局部晚期 ESCC 的临床试验中，纳入了 140 名患者。新辅助放化疗包括每周两次紫杉醇和顺铂为基础的方案以及 40-Gy 放疗（20 次分割）。根据美国癌症联合委员会（American Joint Committee on Cancer，AJCC）第 7 版分期系统对 post-CRT 病理分期进行分类。使用 Cox 回归分析临床病理因素的预后作用。
中位随访 61.9 个月，全队列的中位无进展生存期（progression-free survival，PFS）和总生存期（overall survival，OS）分别为 24.5 个月和 30.9 个月。post-CRT 病理分期为 0 期的患者占 34.5%，I 期的患者占 12.9%，II 期的患者占 29.3%，III 期的患者占 13.6%，ypT0N1-2 期的患者占 6.4%。post-CRT 病理分期为 0、I、II、III 和 ypT0N1-2 期的患者的中位 PFS 分别为 47.2、25.9、16.0、9.4 和 15.1 个月，中位 OS 分别为 57.4、34.1、26.2、14.1 和 17.6 个月。多变量分析显示，体能状态（performance status，PS）（p < 0.001）、肿瘤位置（tumor location，p = 0.016）和淋巴结外扩散（extranodal extension，EPE）（p = 0.024）是 PFS 的独立预后因素，而 PS（p < 0.001）和 post-CRT 病理分期（p = 0.027）是 OS 的独立预后因素。
根据 AJCC 第 7 版分期系统进行分类的 post-CRT 病理分期可以预测接受紫杉醇和顺铂为基础的 nCRT 联合手术治疗的局部晚期 ESCC 患者的生存情况。
