Sugawara Kotaro, Fukuda Takashi, Kishimoto Yutaka, Oka Daiji, Tanaka Yoichi, Hara Hiroki, Yoshii Takako, Kawashima Yoshiyuki
Department of Gastroenterological Surgery, Saitama Cancer Center Hospital, Saitama, Japan.
Department of Gastroenterology, Saitama Cancer Center Hospital, Saitama, Japan.
Ann Surg Oncol. 2023 May;30(5):2703-2712. doi: 10.1245/s10434-022-12945-8. Epub 2022 Dec 26.
Little is known about the survival impacts of pretreatment cancerous stenosis on patients with esophageal carcinoma (EC).
The clinicopathologic characteristics of patients who underwent surgery for EC between January 2010 and December 2018 were retrospectively reviewed. Esophageal stenosis was defined as present when a thin endoscope could not be passed through the tumor site. The impacts of stenosis on overall survival (OS) and cancer-specific survival (CSS) were evaluated using Cox hazards analysis.
Of the 496 EC patients in this study, 51 (10.3 %) had pretreatment esophageal stenosis. Stenosis was associated with lower body mass index (P < 0.001) and higher pStage (P < 0.001). The 3-year OS rate for the patients with stenosis was significantly poorer than for the patients without stenosis (40.2 % vs 69.6 %; hazard ratio [HR], 2.19; P < 0.001). The survival outcomes, especially CSS, for the patients with stenosis were significantly poorer than for the patients without stenosis for both pStage II-III (P = 0.009) and pStage IV (P = 0.006) disease. The OS and CSS curves were well stratified by the presence of stenosis even in early-stage (pStage II) patients (P = 0.04 and P < 0.01, respectively). Multivariable analysis showed esophageal stenosis, pStage III-IV disease, and non-curative resection to be independently associated with poor OS (HR, 1.61; P = 0.02) and poor CSS (HR,1.67; P = 0.02). Higher pStage was an independent predictor of poor CSS for patients without stenosis, but not for those with stenosis.
Esophageal carcinoma patients with pretreatment stenosis had significantly poorer survival outcomes, especially poorer CSS, than those without stenosis in both early- and advanced-stage diseases.
关于癌前狭窄对食管癌（EC）患者生存的影响，目前所知甚少。
回顾性分析2010年1月至2018年12月期间接受食管癌手术患者的临床病理特征。当细内镜无法通过肿瘤部位时，定义为存在食管狭窄。采用Cox风险分析评估狭窄对总生存期（OS）和癌症特异性生存期（CSS）的影响。
本研究的496例EC患者中，51例（10.3%）存在癌前食管狭窄。狭窄与较低的体重指数相关（P<0.001）和较高的p分期相关（P<0.001）。狭窄患者的3年总生存率显著低于无狭窄患者（40.2%对69.6%；风险比[HR]，2.19；P<0.001）。对于pII-III期（P=0.009）和pIV期（P=0.006）疾病，狭窄患者的生存结局，尤其是CSS，显著差于无狭窄患者。即使在早期（pII期）患者中，狭窄的存在也能很好地分层OS和CSS曲线（分别为P=0.04和P<0.01）。多变量分析显示，食管狭窄、pIII-IV期疾病和非根治性切除与较差的OS（HR，1.61；P=0.02）和较差的CSS（HR，1.67；P=0.02）独立相关。较高的p分期是无狭窄患者CSS较差的独立预测因素，但对于有狭窄的患者则不是。
在早期和晚期疾病中，有癌前狭窄的食管癌患者的生存结局显著较差，尤其是CSS更差。
