Department of Gastrointestinal Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
Department of Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
Oncology. 2018;94(6):345-353. doi: 10.1159/000486720. Epub 2018 Apr 27.
The goal of surveillance after therapy of localized esophageal cancer (LEC) is to identify actionable relapses amenable to salvage; however, the current surveillance algorithms are not optimized. We report on a large cohort of LEC patients with actionable locoregional relapses (LRRs).
Between 2000 and 2013, 127 (denominator = 752) patients with actionable LRR were identified. Histologic/cytologic confirmation was the gold standard. All surveillance tools (imaging, endoscopy, fine needle aspiration) were assessed.
Most patients were men (89%), had adenocarcinoma (79%), and had no new symptoms (72%) when diagnosed with LRR. In trimodality patients, endoscopic confirmation of positron emission tomography-computed tomography-suspected LRR occurred in only 44%, and 56% required additional tools (e.g., fine needle aspiration). Alternatively, in bimodality patients, endoscopy confirmed LRRs in 81%. Trimodality patients had a higher risk of subsequent LRR/distant metastases after the first LRR than the bimodality patients (p = 0.03). In all patients, 78% of the subsequent relapses were distant. For patients who were salvaged, survival was significantly prolonged (50.6 vs. 25.1 months, p < 0.01).
Patients live longer after successful salvage of the LRR than if salvage is not possible. After LRR, patients have a high risk of subsequent distant metastasis and whether the second relapse is local or distant, survival is uniformly poor.
局部食管癌（LEC）治疗后监测的目的是识别可进行挽救治疗的局部区域复发病灶；然而，目前的监测方案并不完善。我们报告了一大群有可行动性局部区域复发病灶（LRR）的 LEC 患者。
在 2000 年至 2013 年间，确定了 127 例（分母=752 例）有可行动性 LRR 的患者。组织学/细胞学确认是金标准。评估了所有监测工具（影像学、内镜、细针抽吸）。
大多数患者为男性（89%），患有腺癌（79%），且在诊断为 LRR 时没有新症状（72%）。在三联疗法患者中，正电子发射断层扫描-计算机断层扫描怀疑有 LRR 的内镜证实仅发生在 44%，56%需要额外的工具（如细针抽吸）。相反，在二联疗法患者中，内镜可确认 81%的 LRR。三联疗法患者在首次 LRR 后发生后续 LRR/远处转移的风险高于二联疗法患者（p=0.03）。在所有患者中，78%的后续复发是远处转移。对于接受挽救治疗的患者，生存时间明显延长（50.6 个月比 25.1 个月，p<0.01）。
与不能进行挽救治疗相比，成功挽救 LRR 后患者的生存时间更长。LRR 后，患者有很高的远处转移风险，无论第二次复发是局部还是远处，生存时间均普遍较差。
