在三级转诊中心，新辅助放化疗和根治性食管癌手术后疾病复发的模式。

Patterns of recurrent disease after neoadjuvant chemoradiotherapy and esophageal cancer surgery with curative intent in a tertiary referral center.

机构信息

Amsterdam UMC Location University of Amsterdam, Surgery, Meibergdreef 9, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands; AGEM Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands.

Amsterdam UMC Location Vrije Universiteit Amsterdam, Surgery, De Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands; AGEM Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands.

出版信息

Eur J Surg Oncol. 2023 Oct;49(10):106947. doi: 10.1016/j.ejso.2023.05.022. Epub 2023 Jun 8.

DOI:10.1016/j.ejso.2023.05.022

PMID:37355392

Abstract

BACKGROUND

Recurrence is frequently observed after esophageal cancer surgery, with dismal post-recurrence survival. Neoadjuvant chemoradiotherapy followed by esophagectomy is the gold standard for resectable esophageal tumors in the Netherlands. This study investigated the recurrence patterns and survival after multimodal therapy.

METHODS

This retrospective cohort study included patients with recurrent disease after neoadjuvant chemoradiotherapy followed by esophagectomy for an esophageal adenocarcinoma in the Amsterdam UMC between 01 and 01-2010 and 31-12-2018. Post-recurrence treatment and survival of patients were investigated and grouped by recurrence site (loco-regional, distant, or combined loco-regional and distant).

RESULTS

In total, 278 of 618 patients (45.0%) developed recurrent disease after a median of 49 weeks. Thirty-one patients had loco-regional (11.2%), 145 distant (52.2%), and 101 combined loco-regional and distant recurrences (36.3%). Post-recurrence survival was superior for patients with loco-regional recurrences (33 weeks, 95%CI 7.3-58.7) compared to distant (12 weeks, 95%CI 6.9-17.1) or combined loco-regional and distant recurrent disease (18 weeks, 95%CI 9.3-26.7). Patients with loco-regional recurrences treated with curative intent had the longest survival (87 weeks, 95%CI 6.9-167.4).

CONCLUSION

Recurrent disease after potentially curative treatment for esophageal cancer was most frequently located distantly, with dismal prognosis. A subgroup of patients with loco-regional recurrence was treated with curative intent and had prolonged survival. These patients may benefit from intensive surveillance protocols, and more research is needed to identify these patients.

摘要

背景

食管癌手术后常出现复发，且复发后生存情况较差。新辅助放化疗后行食管癌切除术是荷兰可切除食管肿瘤的金标准。本研究旨在探讨多模式治疗后复发模式和生存情况。

方法

本回顾性队列研究纳入了阿姆斯特丹 UMC 于 2010 年 1 月至 2018 年 12 月期间因食管腺癌行新辅助放化疗后切除术且术后复发的患者。研究调查了患者的复发后治疗和生存情况，并根据复发部位（局部区域、远处或局部区域和远处联合）进行分组。

结果

共有 618 例患者中有 278 例（45.0%）在中位时间 49 周后发生复发。31 例患者为局部区域（11.2%），145 例为远处（52.2%），101 例为局部区域和远处联合复发（36.3%）。局部区域复发患者的复发后生存情况优于远处（33 周，95%CI 7.3-58.7）或局部区域和远处联合（18 周，95%CI 9.3-26.7）复发患者。局部区域复发且接受根治性治疗的患者生存时间最长（87 周，95%CI 6.9-167.4）。