Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
Ann Surg Oncol. 2019 Jul;26(7):2081-2089. doi: 10.1245/s10434-019-07312-z. Epub 2019 Apr 1.
Postoperative complications have a negative impact on overall survival after esophagectomy because systemic inflammation may induce residual cancer cell growth. A solution that could suppress micrometastasis is neoadjuvant therapy; however, to date, no study has shown that neoadjuvant therapy suppresses proliferation of cancer cells due to postoperative complications after esophagectomy. The aim of this study is to investigate the influence of neoadjuvant therapy on poor long-term outcomes of postoperative complications in patients with esophageal carcinoma.
In total, 431 patients who underwent esophagectomy for esophageal squamous cell carcinoma were included in this study. We investigated the relationship between complications, such as pneumonia, and long-term oncologic outcomes with and without neoadjuvant therapy.
Among the patients, the 3-year overall survival (OS) rate was 69.5% and the disease-free survival (DFS) rate was 59.0%. The patients were categorized into two groups: the neoadjuvant therapy (+) group (n = 217) and neoadjuvant therapy (-) group (n = 214). Among patients not undergoing neoadjuvant therapy, patients with pneumonia or pyothorax had significantly poorer OS and DFS than patients without these complications. However, among patients undergoing neoadjuvant therapy, there were no significant differences in long-term outcomes, regardless of presence of complications. On multivariate analysis, pneumonia (p = 0.003), pyothorax (p < 0.001), and chylothorax (p = 0.002) were identified as predictors of death in the neoadjuvant therapy (-) group.
The negative impact of postoperative complications on long-term prognoses can be reduced by performing neoadjuvant therapy in patients with esophageal carcinoma.
术后并发症对食管癌手术后的整体生存有负面影响，因为全身炎症可能会导致残留癌细胞生长。一种可以抑制微转移的方法是新辅助治疗；然而，迄今为止，尚无研究表明新辅助治疗会因食管癌手术后的并发症而抑制癌细胞的增殖。本研究旨在探讨新辅助治疗对食管癌患者术后并发症不良长期结局的影响。
共有 431 例接受食管癌根治术的食管鳞状细胞癌患者纳入本研究。我们研究了肺炎等并发症与新辅助治疗与无新辅助治疗患者长期肿瘤学结局之间的关系。
患者的 3 年总生存率（OS）为 69.5%，无病生存率（DFS）为 59.0%。患者分为两组：新辅助治疗（+）组（n=217）和新辅助治疗（-）组（n=214）。在未接受新辅助治疗的患者中，患有肺炎或脓胸的患者的 OS 和 DFS 明显低于无这些并发症的患者。然而，在接受新辅助治疗的患者中，无论是否存在并发症，长期结局均无显著差异。多因素分析显示，肺炎（p=0.003）、脓胸（p<0.001）和乳糜胸（p=0.002）是新辅助治疗（-）组死亡的预测因素。
在食管癌患者中进行新辅助治疗可以降低术后并发症对长期预后的负面影响。
