食管腺鳞癌应按腺癌还是鳞癌治疗？
Should adenosquamous esophageal cancer be treated like adenocarcinoma or squamous cell carcinoma?
机构信息
Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia.
出版信息
J Surg Oncol. 2020 Sep;122(3):412-421. doi: 10.1002/jso.25990. Epub 2020 May 27.
BACKGROUND
Esophageal adenocarcinoma (AC) and squamous cell carcinoma (SCC) have distinct outcomes, treatment strategies, and response profiles to therapy. Adenosquamous carcinoma (ASC) is thought to behave more aggressively than each of its counterparts. The aim of this study is to determine ifASC is best managed as AC or SCC.
METHODS
National Cancer Database (2004-2015) was queried for patients with nonmetastatic esophageal ASC. The analysis was stratified by clinical node-negative (cN0) or clinical node-positive (cN1-3). Treatment was categorized into chemoradiation alone, surgery alone, or preoperative chemoradiation followed by surgery. The primary outcome was 5-year overall survival (OS).
RESULTS
Among 352 patients, 43% were cN0 (n = 151), 57% were cN1-3 (n = 201) and 55% had chemoradiation alone (n = 194), 15% surgery alone (n = 53), and 30% preoperative chemoradiation (n = 105). Among patients who had preoperative chemoradiation, 20% had pathologic complete response (n = 17). For either cN0 or cN1-3, Charlson-Deyo Comorbidity Index did not differ among the treatment groups(all p > 0.05). On Kaplan-Meier analysis for cN0, treatment with surgery alone had comparable OS to preoperative chemoradiation (47% vs 34%; P = .5) and each had improved OS compared to chemoradiation alone (30%; P = .02; P = .06). On univariate analysis for cN0, clinical T category was not associated with OS. For cN1-3, however, preoperative chemoradiation was associated with improved OS when compared to chemoradiation alone or surgery alone (27% vs 19% vs 0%; P < .001). This persisted when accounting for age and clinical T category (hazard ratio: 0.45; P < .001).
CONCLUSION
Esophageal ASC behaves more like AC in response to chemoradiation and survival based on treatment modality. A complete response to chemoradiation is only 20% unlike what has been shown for SCC, where chemoradiation is an acceptable definitive therapy. Esophageal ASC should be managed more like AC.
背景
食管腺癌 (AC) 和鳞状细胞癌 (SCC) 的预后、治疗策略和对治疗的反应特征明显不同。腺鳞癌 (ASC) 被认为比其各自的癌种更具侵袭性。本研究旨在确定 ASC 是作为 AC 还是 SCC 进行最佳治疗。
方法
从国家癌症数据库 (2004-2015 年) 中查询非转移性食管 ASC 患者。根据临床淋巴结阴性 (cN0) 或临床淋巴结阳性 (cN1-3) 进行分层分析。治疗分为单纯放化疗、单纯手术或术前放化疗后手术。主要结局是 5 年总生存率 (OS)。
结果
在 352 名患者中，43%为 cN0 (n=151)，57%为 cN1-3 (n=201)，55%接受单纯放化疗 (n=194)，15%单纯手术 (n=53)，30%接受术前放化疗 (n=105)。在接受术前放化疗的患者中，20% (n=17) 有病理完全缓解。对于 cN0 或 cN1-3，治疗组之间的 Charlson-Deyo 合并症指数无差异 (均 P>0.05)。在 cN0 的 Kaplan-Meier 分析中，单独手术治疗的 OS 与术前放化疗相当 (47%比 34%；P=0.5)，并且与单纯放化疗相比均改善了 OS (30%；P=0.02；P=0.06)。在 cN0 的单因素分析中，临床 T 分期与 OS 无关。然而，对于 cN1-3，与单纯放化疗或单纯手术相比，术前放化疗可改善 OS (27%比 19%比 0%；P<0.001)。当考虑年龄和临床 T 分期时，这种情况仍然存在 (风险比：0.45；P<0.001)。
结论
在对放化疗的反应和生存方面，食管 ASC 的行为更类似于 AC。与 SCC 不同，放化疗反应仅有 20%完全缓解，而 SCC 中放化疗是一种可接受的确定性治疗。食管 ASC 应更多地作为 AC 进行治疗。
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