Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland.
Division of Biostatistics, School of Public Health, Oregon Health and Science University, Portland.
JAMA Surg. 2016 Nov 16;151(11):e162743. doi: 10.1001/jamasurg.2016.2743.
Pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (CRT) may be a clinical prognostic marker of superior outcomes. In patients with esophageal cancer, pCR is associated with increased survival. While mechanisms for increasing the likelihood of pCR remain unknown, in other solid tumors, higher rates of pCR have been associated with longer time intervals between CRT completion and surgical procedures.
To determine the association between time intervals from the completion of CRT to surgical procedure with rates of pCR in patients with esophageal cancer.
DESIGN, SETTING, AND PARTICIPANTS: A prospectively maintained multidisciplinary foregut database was reviewed for consecutively enrolled patients with esophageal cancer from January 2000 to July 2015 presenting for surgical evaluation at a single National Cancer Institute-designated cancer center within a quaternary academic medical center.
Included patients successfully completed neoadjuvant CRT followed by esophagectomy.
Rate of pCR by logistic regression based on a categorized time interval (ie, 0 to 42, 43 to 56, 57 to 70, 71 to 84, 85 to 98, and 99 or more days) from the completion of CRT to surgical resection, adjusted for clinical stage, demographic information, and CRT regimen.
Of the 234 patients who met inclusion criteria, 191 (81.6%) were male, and the median (range) age was 64 (58-70) years; 206 (88.0%) were diagnosed as having adenocarcinoma, and 65 (27.9%) had a pCR. Patients in the 85 to 98-day group had significantly increased odds of a pCR compared with other groups (odds ratio, 5.46; 95% CI, 1.16-25.68; P = .03). No significant differences in survival were seen between time groups overall or among patients with residual tumor.
This study suggests that a time interval of 85 to 98 days between CRT completion and surgical resection is associated with significantly increased odds of a pCR in patients with esophageal cancer. No adverse association with survival was detected as a result of delaying resection, even in patients with residual tumor.
新辅助放化疗（CRT）后病理完全缓解（pCR）可能是预后良好的临床预后标志物。在食管癌患者中，pCR 与生存率提高相关。虽然增加 pCR 可能性的机制尚不清楚，但在其他实体肿瘤中，pCR 发生率较高与 CRT 完成与手术之间的时间间隔较长有关。
确定食管癌患者从 CRT 完成到手术的时间间隔与 pCR 发生率之间的关系。
设计、设置和参与者：回顾性分析了 2000 年 1 月至 2015 年 7 月期间在一家四等学术医疗中心的国立癌症研究所指定癌症中心接受手术评估的连续入组的食管癌患者的前瞻性维护的多学科前肠数据库。
包括成功接受新辅助 CRT 后接受食管切除术的患者。
根据 CRT 完成到手术切除的时间间隔（即 0 至 42、43 至 56、57 至 70、71 至 84、85 至 98 和 99 天或以上）进行分类，采用 logistic 回归分析 pCR 发生率，调整临床分期、人口统计学信息和 CRT 方案。
在符合纳入标准的 234 例患者中，191 例（81.6%）为男性，中位（范围）年龄为 64（58-70）岁；206 例（88.0%）诊断为腺癌，65 例（27.9%）pCR。与其他组相比，85 至 98 天组患者 pCR 的可能性显著增加（优势比，5.46；95%CI，1.16-25.68；P = .03）。总体上，时间组之间或有残留肿瘤的患者之间的生存无显著差异。
本研究表明，在食管癌患者中，CRT 完成与手术之间的时间间隔为 85 至 98 天与 pCR 可能性显著增加相关。即使在有残留肿瘤的患者中，手术延迟也未发现与生存不良相关。
