Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China.
Ann Surg. 2018 Aug;268(2):289-295. doi: 10.1097/SLA.0000000000002352.
To discern recurrence risk stratification and investigate its influence on postoperative surveillance in patients with esophageal adenocarcinoma (EAC) after neoadjuvant chemoradiotherapy (CRT).
Reports documenting recurrence risk stratification in EAC after neoadjuvant CRT are scarce.
Between 1998 and 2014, 601 patients with EAC who underwent neoadjuvant CRT followed by esophagectomy were included for analysis. The pattern, site, timing, and frequency of the first recurrence and potential prognostic factors for developing recurrences were analyzed. This cohort was used as the training set to propose a recurrence risk stratification system, and the stratification was further validated in another cohort of 172 patients.
A total of 150 patients (25.0%) achieved pathologic complete response (pCR) after neoadjuvant CRT and the rest were defined as the non-pCR group (n = 451) in the training cohort. After a median follow-up of 63.6 months, the pCR group demonstrated a significantly lower locoregional (4.7% vs 19.1%) and distant recurrence rate (22.0% vs.44.6%) than the non-pCR group (P < 0.001). Based on independent prognostic factors, patients were stratified into 4 recurrence risk categories: pCR with clinical stage I/II, pCR with clinical stage III, non-pCR with pN0, and non-pCR with pN+, with corresponding 5-year recurrence-free survival rates of 88.7%, 65.8%, 55.3%, and 33.0%, respectively (P < 0.001). The risk stratification was reproducible in the validation cohort.
We proposed a recurrence risk stratification system for EAC patients based on pathologic response and pretreatment clinical stage. Risk-based postoperative surveillance strategies could be developed for different risk categories.
探讨新辅助放化疗（CRT）后食管腺癌（EAC）患者复发风险分层及其对术后监测的影响。
新辅助 CRT 后 EAC 患者复发风险分层的报道很少。
1998 年至 2014 年间，纳入 601 例接受新辅助 CRT 后行食管切除术的 EAC 患者进行分析。分析首次复发的模式、部位、时间和频率，以及复发的潜在预后因素。该队列被用作训练集，提出一种复发风险分层系统，并在另一队列 172 例患者中进行验证。
在训练队列中，共有 150 例（25.0%）患者在新辅助 CRT 后获得病理完全缓解（pCR），其余 451 例为非 pCR 组。在中位随访 63.6 个月后，pCR 组局部区域（4.7% vs.19.1%）和远处复发率（22.0% vs.44.6%）显著低于非 pCR 组（P < 0.001）。基于独立的预后因素，患者被分为 4 个复发风险类别：pCR 伴临床 I/II 期、pCR 伴临床 III 期、非 pCR 伴 pN0 及非 pCR 伴 pN+，相应的 5 年无复发生存率分别为 88.7%、65.8%、55.3%和 33.0%（P < 0.001）。该分层在验证队列中具有可重复性。
我们提出了一种基于病理反应和术前临床分期的 EAC 患者复发风险分层系统。可针对不同风险类别制定基于风险的术后监测策略。
