Department of Surgical, Oncological and Gastroenterological Sciences, Center for Esophageal Disease, University of Padova, Padua, Italy.
University Hospital, Padua, Italy.
Ann Surg Oncol. 2018 Sep;25(9):2747-2755. doi: 10.1245/s10434-018-6648-6. Epub 2018 Jul 9.
Few studies have examined optimal treatment specifically for cervical esophageal carcinoma. This study evaluated the outcome of three common treatment strategies with a focus on the debated role of surgery.
All patients with cervical esophageal cancer treated at a single center were identified and their outcomes analyzed in terms of morbidity, mortality, and recurrence according to the treatment they received, i.e. surgery alone, definitive platinum-based chemoradiation (CRT), or CRT followed by surgery.
The study population included 148 patients with cervical esophageal cancer from a prospective database of 3445 patients. Primary surgery was the treatment of choice for 56 (37.83%) patients, definitive CRT was the treatment of choice for 52 (35.13%) patients, and CRT followed by surgery was the treatment of choice for 40 (27.02%) patients. CRT-treated patients obtained 36.96% complete clinical response, with overall morbidity and mortality rates of 36.95 and 2.17%, respectively. Surgical complete resection was achieved in 71.88% of surgically treated cases, with morbidity and mortality rates of 52.17 and 6.25%, respectively. No significant survival difference existed among the three treatments, but patients who underwent surgery alone had a significantly lower stage of disease (p = 0.031). Compared with patients with complete response after CRT, surgery did not confer any significant survival benefit, and overall 5-year survival was lower than definitive CRT alone. In contrast, surgery improved survival significantly in patients with non-complete response after definitive CRT (p = 0.023).
Definitive platinum-based CRT should be the treatment of choice for cervical esophageal cancer. Surgery has a role for patients with non-complete response as it adds significant survival benefit, with acceptable morbidity and mortality.
鲜有研究专门针对颈段食管癌的最佳治疗方法。本研究评估了三种常见治疗策略的结果，重点关注手术的争议作用。
从一个 3445 例患者的前瞻性数据库中确定了在单一中心接受治疗的所有颈段食管癌患者，并根据他们接受的治疗方法（单纯手术、确定性含铂放化疗[CRT]或 CRT 后手术）分析其发病率、死亡率和复发情况。
本研究人群包括来自前瞻性数据库的 148 例颈段食管癌患者。56 例（37.83%）患者首选手术治疗，52 例（35.13%）患者首选确定性 CRT 治疗，40 例（27.02%）患者首选 CRT 后手术治疗。CRT 治疗患者的完全临床缓解率为 36.96%，总发病率和死亡率分别为 36.95%和 2.17%。接受手术治疗的患者中，71.88%获得完全切除，发病率和死亡率分别为 52.17%和 6.25%。三种治疗方法之间的生存差异无统计学意义，但单纯手术组患者的疾病分期明显较低（p=0.031）。与 CRT 后完全缓解的患者相比，手术并不能带来显著的生存获益，且总 5 年生存率低于单纯确定性 CRT。相比之下，在 CRT 后无完全缓解的患者中，手术显著改善了生存（p=0.023）。
对于颈段食管癌，确定性含铂 CRT 应作为治疗选择。对于无完全缓解的患者，手术可带来显著的生存获益，且发病率和死亡率可接受。
