Department of Surgery, University Medical Center, Utrecht, The Netherlands; Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands.
Department of Surgery, University Medical Center, Utrecht, The Netherlands.
Eur J Surg Oncol. 2018 May;44(5):620-625. doi: 10.1016/j.ejso.2018.02.005. Epub 2018 Feb 13.
The aim of this population-based cohort study was to determine whether the addition of neoadjuvant chemoradiotherapy (nCRT) to surgery is associated with improved pathologic outcomes and survival in patients with cT2N0M0 esophageal cancer.
Patients who underwent nCRT followed by surgery or surgery alone for cT2N0M0 esophageal cancer were identified from The Netherlands Cancer Registry database (2005-2014). Accuracy of clinical staging was assessed using the resection specimen as gold standard. After propensity score matching, influences of both treatment strategies on radical resection (R0) rates and overall survival were compared.
In total 533 patients were included; 353 underwent nCRT followed by surgery and 180 underwent surgery alone. In the nCRT group 32% of patients achieved a pathologic complete response. Clinical understaging was observed in 62% of the patients in the surgery alone group based on pT-stage (n = 30, 27%), pN-stage (n = 26, 23%), or both (n = 55, 50%). Propensity score matching resulted in 78 patients who underwent nCRT plus surgery versus 78 who underwent surgery alone. In the nCRT group radical resections were more frequently observed (99% vs. 89% p = 0.031) and resulted in improved 5-year overall survival (46% vs. 33%, p = 0.017).
In this population-based study, clinical staging of cT2N0M0 esophageal cancer was highly inaccurate. Compared to surgery alone, neoadjuvant chemoradiotherapy was associated with higher radical resection rates and improved overall survival.
本基于人群的队列研究旨在确定新辅助放化疗（nCRT）联合手术与 cT2N0M0 食管癌患者改善病理结果和生存的相关性。
从荷兰癌症登记数据库（2005-2014 年）中确定接受 nCRT 联合手术或单纯手术治疗 cT2N0M0 食管癌的患者。以切除标本为金标准评估临床分期的准确性。经过倾向评分匹配后，比较两种治疗策略对根治性切除（R0）率和总生存率的影响。
共纳入 533 例患者；353 例行 nCRT 联合手术，180 例行单纯手术。在 nCRT 组中，32%的患者达到病理完全缓解。单纯手术组中，62%的患者基于 pT 分期（n=30，27%）、pN 分期（n=26，23%）或两者（n=55，50%）存在临床低估。经过倾向评分匹配，78 例患者接受 nCRT 联合手术，78 例患者接受单纯手术。nCRT 组中，根治性切除更为常见（99%比 89%，p=0.031），5 年总生存率更高（46%比 33%，p=0.017）。
在本基于人群的研究中，cT2N0M0 食管癌的临床分期高度不准确。与单纯手术相比，新辅助放化疗与更高的根治性切除率和改善的总生存率相关。
