Lopez Anthony, Harada Kazuto, Chen Hsiang-Chun, Bhutani Manoop S, Weston Brian, Lee Jeffrey H, Maru Dipen M, Chin Foo Wai, Rogers Jane E, Thomas Irene, Amlashi Fatemeh G, Blum-Murphy Mariela A, Rice David C, Zhao Meina, Hofstetter Wayne L, Nguyen Quynh, Ajani Jaffer A
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Gastroenterology and Hepatology and Inserm U954, Nancy University Hospital, Lorraine University, Vandoeuvre-lès-Nancy, France.
Medicine (Baltimore). 2020 Feb;99(9):e19295. doi: 10.1097/MD.0000000000019295.
Preoperative chemoradiotherapy (CRT) is one standard option for localized esophageal or gastroesophageal junction (GEJ) cancer patients but an optimal concurrent chemotherapy combination is not established.
412 patients with resectable (cT1N1M0 or cT2-4N0-3M0) esophageal or GEJ cancer treated at the MDACC between October 2002 and June 2016 were analyzed. Exposures: CRT with DF or FOX followed by surgery (trimodality; TMT). Main outcomes and measures: Primary endpoints were overall survival (OS) and disease-free survival (DFS). Univariate and multivariate Cox analyses were performed.
Of the 412 patients analyzed, 264 (64%) received DF and 148 (36%) FOX. The median age was 60 years, and 95% had adenocarcinoma. The clinical complete response, positron-emission tomography response, and pathologic complete response rates were 73%, 73%, and 30%, respectively. Median follow-up was 60.4 months. Median OS for the entire cohort was 81.6 months (95% confidence interval [CI], 56.3-122.0); 81.6 months (95% CI, 55.9-not estimable) for the DF group and 67.7 months (95% CI, 41.6-not estimable) for the FOX group (P = .24). The median DFS was 45.6 months (95% CI, 33.1-61.7) for the entire cohort; 49.5 months (95% CI, 38.6-70.3) for DF and 33.0 months (95% CI, 18.1-70.4; P = .38) for FOX. Higher tumor location (unfavorable) and clinical complete response (favorable) were prognostic for both OS and DFS in the multivariate analysis.
At our high-volume center, the outcome of 412 TMT esophageal cancer patients was excellent. Taxane-based chemotherapy produces nonsignificant favorable trend.
术前放化疗（CRT）是局部食管癌或胃食管交界（GEJ）癌患者的一种标准治疗选择，但最佳的同步化疗方案尚未确立。
对2002年10月至2016年6月在MDACC接受治疗的412例可切除（cT1N1M0或cT2 - 4N0 - 3M0）食管癌或GEJ癌患者进行分析。暴露因素：采用DF或FOX方案进行CRT后行手术（三联治疗；TMT）。主要结局和测量指标：主要终点为总生存期（OS）和无病生存期（DFS）。进行单因素和多因素Cox分析。
在分析的412例患者中，264例（64%）接受DF方案，148例（36%）接受FOX方案。中位年龄为60岁，95%为腺癌。临床完全缓解率、正电子发射断层扫描缓解率和病理完全缓解率分别为73%、73%和30%。中位随访时间为60.4个月。整个队列的中位OS为81.6个月（95%置信区间[CI]，56.3 - 122.0）；DF组为81.6个月（95% CI，55.9 - 不可估计），FOX组为67.7个月（95% CI，41.6 - 不可估计）（P = 0.24）。整个队列的中位DFS为45.6个月（95% CI，33.1 - 61.7）；DF组为49.5个月（95% CI，38.6 - 70.3），FOX组为33.0个月（95% CI，18.1 - 70.4；P = 0.38）。在多因素分析中，较高的肿瘤位置（不利）和临床完全缓解（有利）对OS和DFS均具有预后意义。
在我们这个大型中心，412例接受三联治疗的食管癌患者预后良好。基于紫杉烷的化疗产生了不显著的有利趋势。
