Tanaka Yoshihiro, Yoshida Kazuhiro, Suetsugu Tomonari, Imai Takeharu, Matsuhashi Nobuhisa, Yamaguchi Kazuya
Department of Surgical Oncology Graduate School of Medicine Gifu University Gifu Japan.
Ann Gastroenterol Surg. 2018 May 28;2(4):253-265. doi: 10.1002/ags3.12174. eCollection 2018 Jul.
The 11th edition of the Japanese Classification of Esophageal Cancer (EC) was published in 2017. Some correction was made in the depth of tumor invasion to be consistent with the TNM classification by the Union for International Cancer Control (UICC). With regard to surgery, short-term safety and long-term effectiveness under thoracotomy/video-assisted thoracoscopic surgery are expected to be proven by the Japan Clinical Oncology Group (JCOG)1409 study. Results of nutritional management and countermeasures for adverse events not only during the perioperative period but also during EC chemotherapy were reported. From now on, the pursuit of low invasiveness and radicality is desired. Esophageal surgery is also expected to be safe at all institutions. To determine the optimal modality of preoperative treatment and a novel chemo(radio)therapy regimen for patients with distant metastasis, the results of the ongoing JCOG1109 and 0807 studies are being released. The effect of the addition of molecular targeted drugs on chemotherapy and concurrent chemoradiation has not yet improved overall survival. Immune checkpoint inhibitor drugs could offer a potential new treatment approach for patients with treatment-refractory advanced squamous cell carcinoma (SCC). The Cancer Genome Atlas Research Network reported the results of a comprehensive genome analysis and molecular analysis of SCC and adenocarcinoma of the esophagus. Further differentiation of SCC and adenocarcinoma by molecular characterization analysis may be useful for the development of clinical trials and targeted drug therapies as precision medicine. The era of ultimate minimally invasive surgery and personalized treatment has begun. Large, prospective studies will be required to confirm the value of these advancements.
日本食管癌分类（EC）第11版于2017年出版。对肿瘤浸润深度进行了一些修正，以与国际癌症控制联盟（UICC）的TNM分类保持一致。关于手术，日本临床肿瘤学会（JCOG）1409研究有望证实开胸手术/电视辅助胸腔镜手术下的短期安全性和长期有效性。报告了营养管理结果以及不仅围手术期而且食管癌化疗期间不良事件的应对措施。从现在起，人们期望追求低侵袭性和根治性。食管癌手术在所有机构也应是安全的。为确定远处转移患者术前治疗的最佳方式以及新的化疗（放疗）方案，正在公布正在进行的JCOG1109和0807研究的结果。添加分子靶向药物对化疗和同步放化疗的效果尚未改善总生存期。免疫检查点抑制剂药物可能为治疗难治性晚期鳞状细胞癌（SCC）患者提供一种潜在的新治疗方法。癌症基因组图谱研究网络报告了食管SCC和腺癌的综合基因组分析和分子分析结果。通过分子特征分析进一步区分SCC和腺癌可能有助于开展临床试验和开发作为精准医学的靶向药物疗法。终极微创手术和个性化治疗的时代已经开始。需要进行大型前瞻性研究来证实这些进展的价值。
