Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.
Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
BMC Cancer. 2021 Dec 15;21(1):1334. doi: 10.1186/s12885-021-08896-0.
Neoadjuvant therapy followed by surgery is recommended for locally advanced esophageal cancer. With the inaccuracies of clinical staging particularly for cT1N+ and cT2Nany tumors, some have proposed consideration of surgery followed by adjuvant treatment. Our objective is to evaluate the efficacy of neoadjuvant therapy vs surgery followed by adjuvant therapy, and to identify the ideal sequence of treatment in patients with cT1N+ and cT2Nany tumors.
We performed an analysis utilizing the National Cancer Database (2006-2015) identifying all patients with cT1N+ and cT2Nany esophageal cancer undergoing esophagectomy. The treatment was stratified as: neoadjuvant therapy (NT), adjuvant therapy (AT) and combination therapy of neoadjuvant and adjuvant (CT) groups and outcomes were analyzed.
We identified 2795 patients with 81.9% (n=2289) receiving NT, 10.2% (n=285) AT, and 7.9% (n=221) CT. There were no significant differences noted in survival among AT, NT, and CT group in cT1N+(P=0.376), cT2N-(P=0.436), cT2N+(P=0.261) esophageal cancer by multivariate analysis using Cox regression model. This relationship held true in both squamous cell carcinoma and adenocarcinoma.
In clinical T1N+, T2Nany patients, there was no evident superiority of NT over AT. Surgery followed by adjuvant therapy can be considered to be an alternative option in these patients. Further prospective studies are needed to validate these findings.
新辅助治疗后再行手术是局部晚期食管癌的推荐治疗方法。由于临床分期存在不准确的情况，特别是对于 cT1N+ 和 cT2Nany 肿瘤，一些人提出了考虑先手术再辅助治疗的建议。我们的目的是评估新辅助治疗与手术加辅助治疗的疗效，并确定 cT1N+ 和 cT2Nany 肿瘤患者的理想治疗顺序。
我们利用国家癌症数据库（2006-2015 年）进行了一项分析，确定了所有接受食管癌切除术的 cT1N+ 和 cT2Nany 食管癌患者。治疗分为新辅助治疗（NT）、辅助治疗（AT）和新辅助与辅助联合治疗（CT）三组，并分析了疗效。
我们共确定了 2795 例患者，其中 81.9%（n=2289）接受了 NT，10.2%（n=285）接受了 AT，7.9%（n=221）接受了 CT。多因素 Cox 回归模型分析显示，在 cT1N+（P=0.376）、cT2N-（P=0.436）、cT2N+（P=0.261）食管癌患者中，AT、NT 和 CT 组之间的生存差异无统计学意义。这一关系在鳞癌和腺癌中均成立。
在临床 T1N+、T2Nany 患者中，NT 并不优于 AT。对于这些患者，手术加辅助治疗可以作为一种替代选择。需要进一步的前瞻性研究来验证这些发现。
