Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, Ward 11, District 5, Ho Chi Minh City, Vietnam.
Digestive Surgery Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam.
J Gastrointest Cancer. 2023 Dec;54(4):1240-1251. doi: 10.1007/s12029-023-00915-6. Epub 2023 Feb 1.
Neoadjuvant chemotherapy (NAC) with docetaxel, cisplatin, and 5-fluorouracil/capecitabine (DCF/DCX) followed by esophagectomy has been the recommended treatment for esophageal squamous cell carcinoma (ESCC). However, the optimal interval from NAC to surgery has not yet been established. This study evaluated the impact of time to surgery (TTS) in the treatment of ESCC.
Between August 2018 and September 2021, 97 patients who underwent radical esophagectomy following 3-6 cycles of NAC with DCF/DCX for ESCC at a single hospital were analyzed. TTS was categorized into three groups: 16-41 days (group 1; 33 patients), 42-55 days (group 2; 29 patients), and 56-135 days (group 3; 35 patients). Survival outcomes included overall survival (OS) and progression-free survival (PFS).
Mean age was 59.6 ± 6.8 years, and 95 patients were male. One patient had grade-III anemia, 12 had grade-II anemia, and four had grade-II neutropenia; all other NAC-related toxicities were as grade I. Regarding pathologic tumor response, 18.6% achieved complete response, 71.1% achieved partial response, and 10.3% had stable disease. Forty-eight patients (49.5%) had a postoperative complication, but only six (6.2%) with grade IIIa and two (2.1%) with grade IVa according to the Clavien-Dindo classification. Median follow-up time was 24 months. Groups 1 and 3 had worse OS (HR [95% CI]: 3.36 [1.16-11.7] and 1.83 [0.55-6.10]) and worse PFS (HR [95% CI]: 3.27 [1.25-8.53] and 1.61 [0.58-4.45]) compared to group 2.
We suggest the optimal TTS after NAC is 6-8 weeks. However, this finding must be confirmed by prospective trials.
多西他赛、顺铂和 5-氟尿嘧啶/卡培他滨（DCF/DCX）新辅助化疗（NAC）联合手术治疗食管鳞癌（ESCC）已被推荐为标准治疗方法。然而，NAC 至手术的最佳时间间隔尚未确定。本研究评估了手术时间（TTS）对 ESCC 治疗的影响。
2018 年 8 月至 2021 年 9 月，我院对 97 例接受 3-6 个周期 DCF/DCX 新辅助化疗后行根治性食管切除术的 ESCC 患者进行分析。TTS 分为三组：16-41 天（第 1 组；33 例）、42-55 天（第 2 组；29 例）和 56-135 天（第 3 组；35 例）。生存结果包括总生存（OS）和无进展生存（PFS）。
平均年龄为 59.6±6.8 岁，95 例为男性。1 例发生 III 级贫血，12 例发生 II 级贫血，4 例发生 II 级中性粒细胞减少症；所有其他 NAC 相关毒性均为 I 级。病理肿瘤反应方面，18.6%患者完全缓解，71.1%部分缓解，10.3%疾病稳定。48 例（49.5%）发生术后并发症，但仅 6 例（6.2%）为 IIIa 级，2 例（2.1%）为 IVa 级（根据 Clavien-Dindo 分类）。中位随访时间为 24 个月。第 1 组和第 3 组的 OS 更差（HR[95%CI]：3.36[1.16-11.7]和 1.83[0.55-6.10]），PFS 更差（HR[95%CI]：3.27[1.25-8.53]和 1.61[0.58-4.45]），与第 2 组相比。
我们建议 NAC 后最佳 TTS 为 6-8 周。然而，这一发现必须通过前瞻性试验来证实。
