Departments of Radiation Oncology, Sun Yat-sen University, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Departments of Imaging Diagnosis and Interventional Center, Sun Yat-sen University, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Ann Surg. 2019 Apr;269(4):663-670. doi: 10.1097/SLA.0000000000002670.
To determine the impact of histology on pathologic response, survival outcomes, and recurrence patterns in patients with esophageal cancer (EC) who received neoadjuvant chemoradiotherapy (CRT).
There is a paucity of data regarding comparative outcomes after neoadjuvant CRT between esophageal squamous cell carcinoma (SCC) and adenocarcinoma.
Between 2002 and 2015, 895 EC patients who underwent neoadjuvant CRT followed by esophagectomy at 3 academic institutions were retrospectively reviewed, including 207 patients with SCC (23.1%) and 688 patients with adenocarcinoma (76.9%). Pathologic response, survival, recurrence pattern, and potential prognostic factors were compared.
Pathologic complete response (pCR) rate was significantly higher for SCC compared with adenocarcinoma (44.9% vs 25.9%, P < 0.001). After a median follow-up of 52.9 months, 71 patients (34.3%) with SCC versus 297 patients (43.2%) with adenocarcinoma had recurrent disease (P = 0.023). For patients who achieved a pCR, no significant differences were found in recurrence pattern, sites, or survival end-points between the 2 histology groups. For non-pCR patients, the SCC group demonstrated significantly higher regional and supraclavicular recurrence rates but a lower hematogenous metastasis rate than adenocarcinoma patients, whereas the adenocarcinoma patients had a more favorable locoregional failure-free survival (P = 0.005) and worse distant metastasis-free survival (P = 0.024). No differences were found in overall survival (P = 0.772) or recurrence-free survival (P = 0.696) between groups.
SCC was associated with a significantly higher pCR rate than adenocarcinoma. Recurrence pattern and survival outcomes were significantly different between the 2 histology subtypes in non-pCR patients.
确定接受新辅助放化疗（CRT）的食管癌（EC）患者的组织学对病理反应、生存结果和复发模式的影响。
关于新辅助 CRT 后食管鳞状细胞癌（SCC）和腺癌之间的比较结果数据很少。
在 2002 年至 2015 年间，回顾性分析了在 3 所学术机构接受新辅助 CRT 后行食管切除术的 895 例 EC 患者，包括 207 例 SCC（23.1%）和 688 例腺癌（76.9%）。比较了病理反应、生存、复发模式和潜在的预后因素。
SCC 的病理完全缓解（pCR）率明显高于腺癌（44.9%比 25.9%，P<0.001）。中位随访 52.9 个月后，71 例 SCC 患者（34.3%）与 297 例腺癌患者（43.2%）出现疾病复发（P=0.023）。对于达到 pCR 的患者，两组之间的复发模式、部位或生存终点均无显著差异。对于非 pCR 患者，SCC 组的区域和锁骨上复发率明显高于腺癌组，但血液转移率较低，而腺癌组的局部区域无复发生存率（P=0.005）和远处无转移生存率（P=0.024）更好。两组之间的总生存率（P=0.772）或无复发生存率（P=0.696）无差异。
SCC 的 pCR 率明显高于腺癌。非 pCR 患者中，两种组织学类型之间的复发模式和生存结果有显著差异。
