Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan.
Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan.
Int J Clin Oncol. 2022 Aug;27(8):1289-1299. doi: 10.1007/s10147-022-02190-0. Epub 2022 Jun 8.
The American Society of Anesthesiologists-Physical Status (ASA-PS) classification system has been shown to predict morbidity and mortality after surgery. However, the impact of the ASA-PS on esophageal cancer treatment remains unclear. This study examined both the impact of the ASA-PS on treatment, including surgery and perioperative chemotherapy, and the prognostic effects of ASA-PS class in patients who had undergone esophagectomy for thoracic esophageal cancer or esophagogastric junction cancer.
ASA-PS status was collected for 301 patients who had undergone esophagectomy between January 2007 and June 2016 for thoracic esophageal cancer or esophagogastric junction cancer at a single institution. As the ASA-PS was updated in 2014, the previous classifications of all patients were reevaluated using the updated standard by a surgeon with the previous classifications masked. The dose intensity of preoperative chemotherapy was also compared across classes. Multivariate Cox regression analysis was used to analyze the association between ASA-PS class and overall survival.
Patients whose reevaluations had placed them in a more severe ASA-PS class showed significantly poorer overall and cancer-specific survival rates. The dose intensities of cisplatin and 5-fluorouracil for preoperative chemotherapy were significantly lower in patients in the more severe ASA-PS classes. Multivariate analysis showed that ASA-PS class was an independent prognostic factor for overall survival.
Preoperative ASA-PS classification may influence the intensity of perioperative treatment and may be a valuable long-term prognostic factor for patients with esophageal cancer undergoing esophagectomy.
美国麻醉医师学会-身体状况（ASA-PS）分级系统已被证明可预测手术后的发病率和死亡率。然而，ASA-PS 对食管癌治疗的影响尚不清楚。本研究检查了 ASA-PS 对包括手术和围手术期化疗在内的治疗的影响，以及 ASA-PS 分级在接受胸段食管癌或食管胃交界癌根治性切除术的患者中的预后影响。
收集了 2007 年 1 月至 2016 年 6 月在单家医院接受胸段食管癌或食管胃交界癌根治性切除术的 301 例患者的 ASA-PS 状态。由于 ASA-PS 于 2014 年进行了更新，因此由一位外科医生使用之前的分类方法对所有患者进行了重新评估，而外科医生并不知道之前的分类方法。同时，还比较了各级患者术前化疗的剂量强度。采用多变量 Cox 回归分析来分析 ASA-PS 分级与总生存之间的关系。
重新评估后被归类为更严重 ASA-PS 分级的患者，其总生存率和癌症特异性生存率明显较低。术前化疗中顺铂和 5-氟尿嘧啶的剂量强度在更严重 ASA-PS 分级的患者中明显较低。多变量分析表明，ASA-PS 分级是总生存的独立预后因素。
术前 ASA-PS 分类可能影响围手术期治疗的强度，并且可能是接受食管癌根治性切除术的食管癌患者有价值的长期预后因素。
