显微镜下非根治性食管切除术治疗食管和食管胃交界部癌的结果：全国性队列研究。

Outcome of microscopically non-radical oesophagectomy for oesophageal and oesophagogastric junctional cancer: nationwide cohort study.

机构信息

Department of Surgery, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.

Department of Surgery, Västervik Hospital, Västervik, Sweden.

出版信息

BJS Open. 2021 May 7;5(3). doi: 10.1093/bjsopen/zrab038.

DOI:10.1093/bjsopen/zrab038

PMID:33972990

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8110895/

Abstract

BACKGROUND

Microscopically non-radical (R1) oesophageal cancer resection has been associated with worse survival. The aim of this study was to identify risk factors for R1 resection and to investigate how this affects long-term survival.

METHODS

The Swedish National Register for Oesophageal and Gastric Cancer was used to identify all patients who underwent oesophageal cancer resection with curative intent between 2006 and 2017. Risk factors for R1 resection were assessed by multivariable logistic regression analysis, and factors predicting 5-year survival identified by multivariable Cox regression.

RESULTS

The study included 1460 patients. Surgical margins were involved microscopically in 142 patients (9.7 per cent). The circumferential resection margin was involved in 114 (7.8 per cent), the proximal margin in 53 (3.6 per cent), and the distal margin in 29 (2.0 per cent). In 30 specimens (2.1 per cent), two or all three margins were involved. Independent risk factors for R1 resection were male sex, low BMI, absence of neoadjuvant treatments, and clinical T4 disease. The 5-year survival rate for the entire cohort was 42.2 per cent, but only 18.0 per cent for those who had an R1 resection. Independent risk factors for death within 5 years of resection were male sex, age above 60 years, normal BMI, ASA fitness grade III, intermediate-level education, R1 resection (hazard ratio 1.80, 95 per cent c.i. 1.40 to 2.32), clinical T3 disease, and clinical lymph node metastasis.

CONCLUSION

R1 resection is common and predicts poor 5-year survival. Absence of neoadjuvant treatment is a risk factor for R1 resection.

摘要

背景

显微镜下非根治性（R1）食管切除术与生存率较差相关。本研究旨在确定 R1 切除术的危险因素，并研究其如何影响长期生存。

方法

使用瑞典食管癌和胃癌登记处，确定 2006 年至 2017 年间所有接受根治性食管切除术的患者。通过多变量逻辑回归分析评估 R1 切除术的危险因素，并通过多变量 Cox 回归确定预测 5 年生存率的因素。

结果

研究纳入 1460 例患者。142 例（9.7%）患者的手术切缘存在显微镜下累及。114 例（7.8%）累及环周切缘，53 例（3.6%）累及近端切缘，29 例（2.0%）累及远端切缘，30 例（2.1%）累及两个或所有三个切缘。R1 切除术的独立危险因素为男性、低 BMI、无新辅助治疗和临床 T4 期疾病。全队列的 5 年生存率为 42.2%，但 R1 切除术患者仅为 18.0%。切除后 5 年内死亡的独立危险因素为男性、年龄大于 60 岁、BMI 正常、ASA 体能状态 III 级、中等教育程度、R1 切除术（风险比 1.80，95%置信区间 1.40 至 2.32）、临床 T3 期疾病和临床淋巴结转移。