Blackham Aaron U, H Naqvi Syeda M, Schell Michael J, Jin William, Gangi Alexandra, Almhanna Khaldoun, Fontaine Jacques P, Hoffe Sarah E, Frakes Jessica, Venkat Puja, Pimiento Jose M
Department of Gastrointestinal Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida.
Department of Biostatistics and Bioinformatics, Moffitt Cancer Center and Research Institute, Tampa, Florida.
J Surg Oncol. 2018 Feb;117(2):150-159. doi: 10.1002/jso.24808. Epub 2017 Aug 22.
Despite neoadjuvant chemoradiation (nCRT) followed by esophagectomy for locally advanced esophageal cancer, locoregional recurrence (LRR) is common and factors associated with LRR have not been clearly identified.
Patients were identified from a single institution, prospectively maintained database (1996-2013). Patterns of recurrence were described and associated factors of LRR were analyzed using competing risks regression models.
Of the 456 patients treated with nCRT and surgery, 167 patients developed recurrence. Locoregional and distant recurrences were observed in 69 (15.1%) and 140 (30.9%) patients, respectively. Time to recurrence (13.6 vs 10.4 months, P = 0.20) and median overall survival (29.3 vs 19.1 months, P = 0.12) were no different among the 27 patients (6%) who developed a solitary LRR compared to patients who developed distant recurrence. Univariable analysis identified lymphovascular invasion (HR 1.46, P = 0.07), lymph node ratio >0.5 (HR 2.16, P = 0.02), positive margin (HR 1.95, P = 0.05), lack of response to neoadjuvant therapy (HR 1.99, P < 0.01), clinical T stage (HR 2.62, P < 0.01) and final T3/4 stage (HR 2.06, P < 0.01) as factors significantly associated with LRR. Clinical T stage and response to neoadjuvant treatment were independently associated with LRR on multivariable analysis.
Although aggressive tumor biology plays a significant role in LRR, optimizing neoadjuvant treatments to obtain a complete pathologic response may lead to improved locoregional control.
尽管局部晚期食管癌采用新辅助放化疗（nCRT）后行食管切除术，但局部区域复发（LRR）仍很常见，且与LRR相关的因素尚未明确。
从一个单一机构前瞻性维护的数据库（1996 - 2013年）中识别患者。描述复发模式，并使用竞争风险回归模型分析LRR的相关因素。
在456例行nCRT和手术治疗的患者中，167例出现复发。分别有69例（15.1%）和140例（30.9%）患者出现局部区域复发和远处复发。与出现远处复发的患者相比，27例（6%）出现孤立性LRR的患者的复发时间（13.6个月对10.4个月，P = 0.20）和中位总生存期（29.3个月对19.1个月，P = 0.12）并无差异。单因素分析确定血管淋巴管浸润（HR 1.46，P = 0.07）、淋巴结比率>0.5（HR 2.16，P = 0.02）、切缘阳性（HR 1.95，P = 0.05）、对新辅助治疗无反应（HR 1.99，P < 0.01）、临床T分期（HR 2.62，P < 0.01）和最终T3/4期（HR 2.06，P < 0.01）为与LRR显著相关的因素。多因素分析显示临床T分期和对新辅助治疗的反应与LRR独立相关。
尽管侵袭性肿瘤生物学在LRR中起重要作用，但优化新辅助治疗以获得完全病理缓解可能会改善局部区域控制。
