Department of General, Visceral, Endocrine and Transplant Surgery, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland.
SAKK Coordinating Centre, Berne, Switzerland.
Ann Surg. 2019 Jan;269(1):83-87. doi: 10.1097/SLA.0000000000002435.
The long-term follow up data of 2 prospective phase II trials is reported (NCT00072033, NCT00445861), which investigated neoadjuvant chemoradiation followed by surgery in patients with esophageal carcinoma. Postoperative complications as well as prognostic factors and patterns of relapse during long-term observation are shown.
Long-term follow-up is often missing in the complex setting of multimodal treatments of esophageal carcinoma; this leads to rather undifferentiated follow-up guidelines for this tumor entity.
In the first trial, patients received induction chemotherapy followed by chemoradiation and surgery. In the second trial, cetuximab was added to the same neoadjuvant treatment concomitant with induction chemotherapy and chemoradiation.
Eighty-two patients underwent surgery; the median follow-up time was 6.8 and 6.4 years, respectively. Fifty-five percent were diagnosed with adenocarcinoma, 80% clinically node-positive, 68% received transthoracic esophagectomy, and 32% transhiatal or transmediastinal resection. Five patients died postoperatively in-hospital due to complications (6%). The median overall survival was 4.3 years, and the median event-free survival was 2.7 years. Patients with adenocarcinoma rarely relapsed after a 3-year event-free survival. Whereas patients with residual tumor cells after neoadjuvant therapy primarily experienced relapse within the first 2 postoperative years, this in contrast to several patients with complete remission who also experienced late relapses 4 years after surgery.
After curative surgery in a multimodal setting, the histological type and the response to neoadjuvant therapy predicted the time frame of relapse; this knowledge may influence further follow-up guidelines for esophageal carcinoma.
报告 2 项前瞻性 II 期试验的长期随访数据（NCT00072033，NCT00445861），这些试验研究了新辅助放化疗后行食管癌手术的患者。显示了术后并发症以及长期观察期间的预后因素和复发模式。
在食管癌多模式治疗的复杂环境中，长期随访往往缺失；这导致针对该肿瘤实体的随访指南相当不明确。
在第一项试验中，患者接受诱导化疗，然后进行放化疗和手术。在第二项试验中，西妥昔单抗与诱导化疗和放化疗同时添加到相同的新辅助治疗中。
82 例患者接受了手术；中位随访时间分别为 6.8 年和 6.4 年。55%被诊断为腺癌，80%临床淋巴结阳性，68%接受经胸食管切除术，32%接受经食管裂孔或经纵隔切除术。术后 5 例患者因并发症（6%）在院内死亡。中位总生存期为 4.3 年，中位无事件生存期为 2.7 年。腺癌患者在 3 年无事件生存后很少复发。而新辅助治疗后有残余肿瘤细胞的患者主要在前 2 年术后复发，与一些完全缓解的患者形成对比，这些患者在手术后 4 年也经历了晚期复发。
在多模式治疗后进行根治性手术，组织学类型和对新辅助治疗的反应预测了复发时间框架；这一知识可能会影响食管癌的进一步随访指南。
