Hilgenberg A D, Carey R W, Wilkins E W, Choi N C, Mathisen D J, Grillo H C
Surgical Services, Massachusetts General Hospital, Boston 02114.
Ann Thorac Surg. 1988 Apr;45(4):357-63. doi: 10.1016/s0003-4975(98)90004-2.
In an attempt to improve on the long-term survival rate of patients with esophageal squamous cell carcinoma, we designed a study in which treatment included preoperative chemotherapy with fluorouracil and cisplatin, surgical resection, and selective postoperative chemotherapy or radiation therapy. Between 1981 and 1986, 35 patients with potentially resectable lesions were entered into the study. After chemotherapy, 13 of 35 patients (37%) had a complete clinical response, 7 (20%) had a partial response, and 15 (43%) had no response. One patient sustained a serious toxic reaction (renal failure). Twenty-seven patients underwent surgical resection, with 1 hospital death (3.7%). Selective postoperative radiotherapy or chemotherapy was administered to 69%. The actuarial survival of all resected patients at 42 months was 54% (standard error, 10%). Multivariate analysis showed significant factors associated with 3-year survival were: (1) complete clinical response to chemotherapy; (2) absence of wall penetration in the specimen; and (3) microscopic or no disease in the specimen. We conclude that this multimodality treatment method improves the intermediate-term survival of patients with squamous cell carcinoma of the esophagus.
为提高食管鳞状细胞癌患者的长期生存率，我们设计了一项研究，其治疗包括术前使用氟尿嘧啶和顺铂进行化疗、手术切除以及选择性术后化疗或放疗。1981年至1986年间，35例具有潜在可切除病灶的患者进入该研究。化疗后，35例患者中有13例（37%）获得完全临床缓解，7例（20%）部分缓解，15例（43%）无反应。1例患者出现严重毒性反应（肾衰竭）。27例患者接受了手术切除，1例住院死亡（3.7%）。69%的患者接受了选择性术后放疗或化疗。所有切除患者42个月时的精算生存率为54%（标准误，10%）。多因素分析显示与3年生存率相关的显著因素为：（1）化疗后完全临床缓解；（2）标本中无壁穿透；（3）标本中显微镜下无疾病或无病变。我们得出结论，这种多模式治疗方法可提高食管鳞状细胞癌患者的中期生存率。
