Jiang Di M, Suzuki Chihiro, Espin-Garcia Osvaldo, Lim Charles H, Ma Lucy X, Sun Peiran, Sim Hao-Wen, Natori Akina, Chan Bryan A, Moignard Stephanie, Chen Eric X, Liu Geoffrey, Swallow Carol J, Darling Gail E, Wong Rebecca, Jang Raymond W, Elimova Elena
Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Cancer Med. 2020 May;9(9):3023-3032. doi: 10.1002/cam4.2948. Epub 2020 Mar 4.
The goal of surveillance testing is to enable curative salvage therapy through early disease detection, however supporting evidence in gastroesophageal adenocarcinoma is limited. We evaluated frequency of successful salvage therapy and outcomes in patients who underwent surveillance.
A single-site, retrospective cohort study was conducted to identify all patients who received curative resection for gastroesophageal adenocarcinoma. Surveillance testing were those investigations not triggered by abnormal symptoms, physical examination, or blood tests. Successful salvage therapy was any potentially curative therapy for disease recurrence which resulted in postrecurrence disease-free survival ≥2 years. Time-to-event data were analyzed using the Kaplan-Meier method and log rank tests.
Between 2011 and 2016, 210 consecutive patients were reviewed. Esophageal (14%), gastroesophageal junction (40%), and gastric adenocarcinomas (45%) were treated with surgery alone (29%) or multimodality therapy (71%). Adjuvant therapy was administered in 35%. At median follow-up of 38.3 months, 5-year overall survival (OS) rate was 56%. Among 97 recurrences, 53% were surveillance-detected, and 46% were symptomatic. None was detected by surveillance endoscopy. Median time-to-recurrence (TTR) was 14.8 months. Recurrences included locoregional only (4%), distant (86%), and both (10%). Salvage therapy was attempted in 15 patients, 4 were successful. Compared to symptomatic recurrences, patients with surveillance-detected recurrences had longer median OS (36.2 vs 23.7 months, P = .004) and postrecurrence survival (PRS, 16.5 vs 4.6 months, P < .001), but similar TTR (16.2 vs 13.3 months, P = .40) and duration of palliative chemotherapy (3.9 vs 3.3 months, P = .64).
Among patients surveyed, 96% of recurrences were distant, and salvage therapy was successful in only 1.9% of patients. Longer OS in patients with surveillance-detected compared to symptomatic recurrences was not associated with significant earlier disease detection, and may be contributed by differences in disease biology. Further prospective data are warranted to establish the benefit of surveillance testing in gastroesophageal adenocarcinoma.
监测性检测的目标是通过早期疾病检测实现根治性挽救治疗，然而在胃食管腺癌方面的支持证据有限。我们评估了接受监测的患者中成功挽救治疗的频率和结局。
进行了一项单中心回顾性队列研究，以确定所有接受胃食管腺癌根治性切除术的患者。监测性检测是指那些并非由异常症状、体格检查或血液检查引发的检查。成功的挽救治疗是指对疾病复发进行的任何可能根治性的治疗，其导致复发后无病生存期≥2年。使用Kaplan-Meier方法和对数秩检验分析事件发生时间数据。
2011年至2016年期间，对210例连续患者进行了回顾。食管腺癌（14%）、胃食管交界腺癌（40%）和胃腺癌（45%）接受了单纯手术治疗（29%）或多模式治疗（71%）。35%的患者接受了辅助治疗。中位随访38.3个月时，5年总生存率（OS）为56%。在97例复发患者中，53%是通过监测发现的，而有症状的复发占46%。监测内镜未发现任何复发。中位复发时间（TTR）为14.8个月。复发包括仅局部区域复发（4%）、远处复发（86%）和两者皆有（10%）。15例患者尝试了挽救治疗，4例成功。与有症状的复发相比，监测发现复发的患者中位OS更长（36.2个月对23.7个月，P = 0.004），复发后生存期（PRS）更长（16.5个月对4.6个月，P < 0.001），但TTR相似（16.2个月对13.3个月，P = 0.40），姑息化疗持续时间也相似（3.9个月对3.3个月，P = 0.64）。
在接受调查的患者中，96%的复发为远处复发，挽救治疗仅在1.9%的患者中成功。与有症状的复发相比，监测发现复发的患者OS更长，但这与更早的疾病检测并无显著关联，可能是由疾病生物学差异导致的。需要进一步的前瞻性数据来确定监测性检测在胃食管腺癌中的益处。
