Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0879, Japan.
Department of Surgery, Osaka General Medical Center, Osaka, Japan.
Esophagus. 2021 Jul;18(3):559-565. doi: 10.1007/s10388-020-00811-z. Epub 2021 Feb 12.
Esophageal cancer typically has a poor prognosis. While neoadjuvant chemotherapy (NAC) is reported to be effective for esophageal cancer patients, the prognosis of patients for whom NAC is ineffective remains poor.
In total, 113 patients with thoracic esophageal squamous cell carcinoma who were treated between January 2006 and December 2015 were enrolled. These patients received NAC followed by radical surgery and had three or more pathologic positive lymph nodes. The effectiveness and feasibility of adjuvant chemotherapy (AC) were evaluated.
Forty patients received AC (AC(+) group) and 73 patients did not (AC(-) group). Two-year relapse-free survival (RFS) rates of the AC(+) and AC(-) groups were 30.0% and 28.8%, respectively (p = 0.47). These patients were further divided into two subgroups, i.e., those with 3-6 positive lymph nodes (3-6 subgroup) and those with ≥ 7 positive lymph nodes (≥ 7 subgroup). Within the 3-6 subgroup (72 patients), 2-year RFS rates of the AC(+) and AC(-) groups were 38.5% and 33.9%, respectively (p = 0.31). Within the ≥ 7 subgroup (41 patients), 2-year RFS rates of the AC(+) and AC(-) groups were 25.9% and 7.1%, respectively (p = 0.04).
AC may offer a significant additional benefit to the prognosis of esophageal cancer patients who have many positive lymph nodes even after NAC.
食管癌预后通常较差。虽然新辅助化疗（NAC）被报道对食管癌患者有效，但 NAC 无效患者的预后仍然较差。
共纳入 113 例 2006 年 1 月至 2015 年 12 月期间接受治疗的胸段食管鳞状细胞癌患者。这些患者接受 NAC 后行根治性手术，且有 3 个或以上病理性阳性淋巴结。评估辅助化疗（AC）的有效性和可行性。
40 例患者接受 AC（AC(+)组），73 例未接受（AC(-)组）。AC(+)组和 AC(-)组的 2 年无复发生存率（RFS）分别为 30.0%和 28.8%（p=0.47）。这些患者进一步分为 3-6 个阳性淋巴结亚组（72 例）和≥7 个阳性淋巴结亚组（41 例）。在 3-6 个阳性淋巴结亚组（72 例）中，AC(+)组和 AC(-)组的 2 年 RFS 率分别为 38.5%和 33.9%（p=0.31）。在≥7 个阳性淋巴结亚组（41 例）中，AC(+)组和 AC(-)组的 2 年 RFS 率分别为 25.9%和 7.1%（p=0.04）。
即使在 NAC 后仍有大量阳性淋巴结的食管癌患者，AC 可能会显著改善预后。
