Sheil Fiachra, Donohoe Claire L, King Sinéad, O'Toole Dermot, Cunningham Moya, Cuffe Sinéad, Ravi Narayanasamy, Reynolds John V
Department of Surgery, St. James's Hospital, Trinity College Dublin, Dublin, Ireland.
Department of Medicine, St. James's Hospital, Trinity College Dublin, Dublin, Ireland.
World J Surg. 2018 May;42(5):1485-1495. doi: 10.1007/s00268-017-4289-8.
The standard of care for treatment of oesophageal squamous cell carcinoma (SCC) continues to evolve. Neoadjuvant chemoradiotherapy (neoCRT) provides a significant survival benefit compared to surgery alone but it is unclear whether definitive chemoradiation (dCRT) is superior.
Retrospective analysis of outcomes from patients treated in a national high-volume centre (2000-2014) where both neoCRT and dCRT are used with curative intent. Propensity score match analysis was used to match patients undergoing dCRT with those undergoing surgery ± neoCRT.
A total of 668 patients were treated for SCC in this time period, 361 (54.0%) of whom were treated with curative intent. In patients treated with curative intent, 179 (49.6%) had dCRT, and of these 32 (18%) did not complete the treatment regimen. One hundred and seven patients (29.6%) underwent surgery only, and 75 patients (20.8%) had multimodal therapy. The proportion of patients treated with curative intent increased over this time period. The five-year disease-specific and overall survival rate of patients treated with multimodal therapy was 62 and 50%, respectively, compared with 25 and 20% for patients the dCRT group and 44 and 38%, respectively, for the surgery only cohort (p < 0.001). Patients with a complete pathological response had a 90% five-year disease-specific survival and 76% overall survival rate. Multimodal treatment rather than dCRT was a significant predictor of overall survival (OR 1.7 95% CI 1.3-2.4, p = 0.002). In 106 patients matched, those undergoing dCRT had a significantly poorer overall survival versus those receiving surgery as a component of their care (20.47 ± 3.74 months versus 30.65 ± 10.07 months, p = 0.002).
This study provides evidence, consistent with CROSS data, that multimodal therapy for SCC can provide excellent outcomes with respect to overall survival, pathologic complete response rates, R0 resections and treatment-related mortality. A large RCT with specific arms for multimodal, dCRT and surgery alone is required.
食管鳞状细胞癌（SCC）的治疗标准不断发展。与单纯手术相比，新辅助放化疗（neoCRT）可带来显著的生存获益，但根治性放化疗（dCRT）是否更具优势尚不清楚。
对一家全国大型中心（2000 - 2014年）以治愈为目的接受neoCRT和dCRT治疗的患者结局进行回顾性分析。采用倾向评分匹配分析将接受dCRT的患者与接受手术±neoCRT的患者进行匹配。
在此期间，共有668例患者接受SCC治疗，其中361例（54.0%）以治愈为目的进行治疗。在以治愈为目的治疗的患者中，179例（49.6%）接受了dCRT，其中32例（18%）未完成治疗方案。107例患者（29.6%）仅接受了手术，75例患者（20.8%）接受了多模式治疗。在此期间，以治愈为目的治疗的患者比例有所增加。接受多模式治疗的患者的五年疾病特异性生存率和总生存率分别为62%和50%，而dCRT组患者分别为25%和20%，单纯手术队列患者分别为44%和38%（p < 0.001）。达到完全病理缓解的患者五年疾病特异性生存率为90%，总生存率为76%。多模式治疗而非dCRT是总生存的显著预测因素（OR 1.7，95% CI 1.3 - 2.4，p = 0.002）。在106例匹配患者中，接受dCRT的患者的总生存期明显低于接受手术作为其治疗一部分的患者（20.47 ± 3.74个月对30.65 ± 10.07个月，p = 0.002）。
本研究提供了与CROSS数据一致的证据，即SCC的多模式治疗在总生存、病理完全缓解率、R0切除率和治疗相关死亡率方面可带来优异的结果。需要开展一项针对多模式、dCRT和单纯手术的大型随机对照试验。
