围手术期 FLOT 化疗联合手术治疗寡转移性胃食管腺癌：手术结果和总生存。

Perioperative FLOT chemotherapy plus surgery for oligometastatic esophagogastric adenocarcinoma: surgical outcome and overall survival.

机构信息

Department of General - and Visceral Surgery, Medical Center, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany.

Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.

出版信息

BMC Surg. 2021 Jan 13;21(1):35. doi: 10.1186/s12893-020-01035-9.

BACKGROUND

Guidelines do not recommend surgery for patients with oligometastatic disease from esophagogastric adenocarcinoma (EGAC), although some studies suggest a more favorable survival. We analyzed the outcome of oligometastatic EGAC receiving FLOT chemotherapy followed by surgery.

METHODS

The data of patients with either pre-therapeutic, post-neoadjuvant or intraoperative clinical diagnosis of oligometastatic EGAC were extracted from a prospective database of the 2009-2018 treatment period. 48 consecutive patients were identified with oligometastatic disease, who underwent perioperative chemotherapy plus surgery. We retrospectively analyzed surgical outcome and overall survival.

RESULTS

The overall 5-year survival was 18%. 12 patients (25%) with pre-therapeutic oligometastatic EGAC, who had no histologic vital tumor evidence of metastases after surgery had a survival rate of 48% compared to an 11% 5-year survival rate of 36 patients (75%), who had histologic vital tumor metastatic evidence after FLOT chemotherapy and surgical resection (p = 0.012). The survival rates after R0, R1 and R2 (non-resected metastases) resection were 21% (n = 33), 0% (n = 4) and 17% (n = 11), respectively (p = 0.273).

CONCLUSION

Oligometastatic EGAC is associated with poor overall survival even after complete resection of all tumor manifestations. The subgroup of patients with a complete histologic response of metastatic lesions to neoadjuvant FLOT shows 5-year survival rates similar to non-metastatic EGAC. Trial registration Not applicable.

背景

指南不建议对患有食管胃腺癌（EGAC）寡转移疾病的患者进行手术，尽管一些研究表明这种疾病的生存率更高。我们分析了接受 FLOT 化疗后再行手术的寡转移 EGAC 患者的结果。

方法

从 2009 年至 2018 年治疗期间的前瞻性数据库中提取了术前、新辅助后或术中临床诊断为寡转移 EGAC 的患者数据。确定了 48 例接受围手术期化疗加手术的寡转移疾病患者。我们回顾性分析了手术结果和总生存情况。

结果

总体 5 年生存率为 18%。12 例（25%）术前诊断为寡转移 EGAC 的患者，手术后无组织学证据显示转移灶有存活肿瘤，其 5 年生存率为 48%，而 36 例（75%）在接受 FLOT 化疗和手术切除后有组织学证据显示存活肿瘤转移的患者 5 年生存率为 11%（p=0.012）。RO、R1 和 R2（未切除转移灶）切除后的生存率分别为 21%（n=33）、0%（n=4）和 17%（n=11）（p=0.273）。