Okamura A, Watanabe M, Mine S, Kurogochi T, Yamashita K, Hayami M, Imamura Y, Ogura M, Ichimura T, Takahari D, Chin K
Department of Gastroenterological Surgery.
Department of Gastroenterological Medicine, Gastoroenterology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan.
Dis Esophagus. 2017 Sep 1;30(9):1-8. doi: 10.1093/dote/dox075.
Neoadjuvant treatment has become standard care for patients with resectable esophageal cancer. However, some patients cannot undergo surgery or curative resection because of disease progression during neoadjuvant treatment. The aim of this study is to identify the pretreatment characteristics of patients in whom neoadjuvant treatment failed. The study enrolled 231 patients who underwent chemotherapy with cisplatin and 5-fluorouracil (CF) as neoadjuvant therapy for T1N1-3 or T2-3 any-N esophageal squamous cell carcinoma (ESCC). Of these patients, 201 (87.0%) underwent curative resection (R0) and 30 (13.0%) could not undergo curative resection; 19 patients (8.2%) underwent incomplete resection (R1 or R2), and 11 patients (4.8%) could not undergo surgery because of disease progression. We compared clinical characteristics and survival between patients who underwent curative resection (curative group) and those who could not undergo curative resection (noncurative group) to determine the factors predicting noncurative treatment. The noncurative group had significantly worse disease-specific survival than the curative group (P < 0.001). All patients in the noncurative group had cT3 tumors. In 141 patients with cT3 tumors, those in the noncurative group were more likely to have higher serum SCC antigen concentration (P = 0.021), location of the main tumor in the upper to the middle third of the esophagus (P = 0.071), intramural metastases (P < 0.001), advanced N category (P = 0.016), and bulky lymph node metastases (P = 0.060). Multivariate logistic regression analysis identified location of the main tumor in the upper to the middle third of the esophagus (P = 0.047), intramural metastases (P = 0.002), and nodal metastases (N1, P = 0.014; N2, P = 0.015, respectively) as independent predictors of treatment failure in patients with cT3 tumors. Neoadjuvant CF therapy alone may not be effective for patients with cT3 tumors accompanied by these risk factors, and the efficacy of alternative strategies, such as triplet chemotherapy or chemoradiotherapy, should be evaluated.
新辅助治疗已成为可切除食管癌患者的标准治疗方法。然而，一些患者由于在新辅助治疗期间疾病进展而无法接受手术或根治性切除。本研究的目的是确定新辅助治疗失败患者的治疗前特征。该研究纳入了231例接受顺铂和5-氟尿嘧啶（CF）化疗作为T1N1-3或T2-3任何N期食管鳞状细胞癌（ESCC）新辅助治疗的患者。在这些患者中，201例（87.0%）接受了根治性切除（R0），30例（13.0%）无法进行根治性切除；19例（8.2%）接受了不完全切除（R1或R2），11例（4.8%）由于疾病进展而无法进行手术。我们比较了接受根治性切除的患者（根治组）和无法进行根治性切除的患者（非根治组）的临床特征和生存率，以确定预测非根治性治疗的因素。非根治组的疾病特异性生存率明显低于根治组（P < 0.001）。非根治组的所有患者均有cT3肿瘤。在141例cT3肿瘤患者中，非根治组患者更有可能具有较高的血清鳞状细胞癌抗原浓度（P = 0.021）、主肿瘤位于食管上三分之一至中三分之一（P = 0.071）、壁内转移（P < 0.001）、晚期N分期（P = 0.016）和巨大淋巴结转移（P = 0.060）。多因素逻辑回归分析确定主肿瘤位于食管上三分之一至中三分之一（P = 0.047）、壁内转移（P = 0.002）和淋巴结转移（N1，P = 0.014；N2，P = 0.015）是cT3肿瘤患者治疗失败的独立预测因素。单独的新辅助CF治疗可能对伴有这些危险因素的cT3肿瘤患者无效，应评估三联化疗或放化疗等替代策略的疗效。
