Glatz Torben, Verst Rasmus, Kuvendjiska Jasmina, Bronsert Peter, Becker Heiko, Hoeppner Jens, Kulemann Birte
Department of Surgery, Marien Hospital Herne, Ruhr-University Bochum, Hölkeskampiring 40, 44625 Herne, Germany.
Center for Surgery, Department of General and Visceral Surgery, Medical Center-University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
J Clin Med. 2020 Aug 16;9(8):2654. doi: 10.3390/jcm9082654.
The 5-FU, Leucovorin, Oxaliplatin and Docetaxel (FLOT) protocol provides superior oncologic results compared to other perioperative chemotherapeutic protocols for the treatment of non-metastatic esophagogastric cancer (EGAC). Survival and the pattern of recurrence of EGAC after FLOT and curative tumor resection are analyzed in a collective of patients treated outside clinical trials.
Two-hundred-seventy-seven patients with EGAC (cT3-4 and/or cN+) were treated with perioperative FLOT-chemotherapy plus curative surgery between 2009 and 2018. Data were analyzed retrospectively from a prospective database.
Two-hundred-twenty-eight patients were included in the analysis. Postoperative in-hospital mortality was 2%. The median survival was 61-months, and median recurrence-free survival was 42 months. Multivariate analysis identified postoperative nodal status and T-stage as independent predictors of improved overall and recurrence-free survival. Administration of adjuvant chemotherapy failed to be significant for overall survival but was an independent predictor of recurrence-free survival. Recurrence occurred after a median of 9 months (range 1-46 months). Eighty-nine percent of recurrence occurred during the first 24 months. The rate of local recurrence was low. After surgery for gastric cancer, the major recurrence site was peritoneal carcinomatosis (56%), while esophageal cancer recurred mostly as metastasis to distant organs (78%). The specific site of recurrence had no impact on overall survival time.
Real-life application of FLOT shows oncologic results comparable to clinical trials. Recurrence after FLOT and surgery for EGAC occurs predominantly early within the first two years after surgery and in the form of distant organ metastasis for esophageal tumors or peritoneal carcinomatosis for gastric tumors.
与其他用于治疗非转移性食管胃癌（EGAC）的围手术期化疗方案相比，5-氟尿嘧啶、亚叶酸钙、奥沙利铂和多西他赛（FLOT）方案具有更优的肿瘤学疗效。在一组非临床试验治疗的患者中，分析了接受FLOT方案及根治性肿瘤切除术后EGAC的生存率和复发模式。
2009年至2018年期间，277例EGAC（cT3-4和/或cN+）患者接受了围手术期FLOT化疗加根治性手术。数据来自前瞻性数据库并进行回顾性分析。
228例患者纳入分析。术后住院死亡率为2%。中位生存期为61个月，中位无复发生存期为42个月。多变量分析确定术后淋巴结状态和T分期是总体生存和无复发生存改善的独立预测因素。辅助化疗对总生存期无显著影响，但却是无复发生存的独立预测因素。复发的中位时间为9个月（范围1-46个月）。89%的复发发生在术后前24个月内。局部复发率较低。胃癌手术后，主要复发部位是腹膜种植转移（56%），而食管癌大多复发为远处器官转移（78%）。复发的具体部位对总生存时间无影响。
FLOT方案的实际应用显示出与临床试验相当的肿瘤学疗效。EGAC患者接受FLOT方案及手术后的复发主要发生在术后头两年内，食管癌以远处器官转移的形式复发，胃癌以腹膜种植转移的形式复发。
