Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institute, and Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
Department of Surgery, Skåne University Hospital, Lund University, Lund, Sweden.
Br J Surg. 2016 Dec;103(13):1864-1873. doi: 10.1002/bjs.10304. Epub 2016 Sep 30.
Randomized trials have shown that neoadjuvant treatment improves survival in the curative treatment of oesophageal and gastro-oesophageal junction cancer. Results from population-based observational studies are, however, sparse and ambiguous.
This prospective population-based cohort study included all patients who had oesophagectomy for cancer in Sweden, excluding clinical T1 N0, recorded in the National Register for Oesophageal and Gastric Cancer, 2006-2014. Patients were stratified into three groups: surgery alone, neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy.
Neoadjuvant treatment was given to 521 patients (51·1 per cent) and 499 (48·9 per cent) received surgery alone. Neoadjuvant chemotherapy increased the risk of postoperative surgical complications compared with surgery alone (adjusted odds ratio 2·01, 95 per cent c.i. 1·24 to 3·25; P = 0·005). Postoperative mortality was significantly increased after neoadjuvant chemoradiotherapy compared with surgery alone (odds ratio 2·37, 1·06 to 5·29; P = 0·035). Survival improved in patients with squamous cell carcinoma after neoadjuvant chemotherapy, whereas after neoadjuvant chemoradiotherapy survival was significantly improved only in the subgroup with the highest performance status and without known co-morbidity. In adenocarcinoma there was a trend towards improved overall survival after neoadjuvant chemotherapy, but neoadjuvant chemoradiotherapy did not offer a survival benefit. Stratified analysis including only patients with adenocarcinoma in the highest performance category without known co-morbidity showed a strong trend towards improved survival after neoadjuvant chemotherapy compared with surgery alone (adjusted hazard ratio 0·47, 0·21 to 1·04; P = 0·061).
For patients with squamous cell carcinoma of the oesophagus or gastro-oesophageal junction, neoadjuvant treatments seemed to increase long-term survival, but also the risk of postoperative morbidity and mortality, compared with surgery alone. Neither neoadjuvant treatment option seemed to improve survival significantly among patients with adenocarcinoma, compared with surgery alone.
随机试验表明，新辅助治疗可改善食管和胃食管交界部癌的治愈性治疗的生存率。然而，基于人群的观察性研究结果却很少且存在歧义。
本项前瞻性基于人群的队列研究纳入了瑞典全国食管和胃癌登记处 2006 年至 2014 年间记录的所有接受手术治疗的食管癌或胃食管交界部癌患者，但不包括临床 T1N0 患者。患者分为三组：单纯手术、新辅助化疗和新辅助放化疗。
521 例（51.1%）患者接受了新辅助治疗，499 例（48.9%）患者单纯接受手术。与单纯手术相比，新辅助化疗增加了术后手术并发症的风险（校正优势比 2.01，95%置信区间 1.24 至 3.25；P=0.005）。与单纯手术相比，新辅助放化疗后术后死亡率显著增加（比值比 2.37，1.06 至 5.29；P=0.035）。新辅助化疗可改善鳞癌患者的生存，而新辅助放化疗仅在功能状态最高且无已知合并症的亚组中显著改善生存。腺癌患者中，新辅助化疗后总生存有改善趋势，但新辅助放化疗并未带来生存获益。包括功能状态最高且无已知合并症的腺癌患者在内的分层分析显示，与单纯手术相比，新辅助化疗后生存有明显改善趋势（校正风险比 0.47，0.21 至 1.04；P=0.061）。
对于食管或胃食管交界部鳞癌患者，与单纯手术相比，新辅助治疗似乎可提高长期生存率，但也增加了术后发病率和死亡率的风险。与单纯手术相比，新辅助治疗方案似乎并未显著改善腺癌患者的生存。
