Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada.
Department of Medical Oncology, Hopital de Gatineau, Gatineau, QC, Canada.
Ann Surg Oncol. 2024 Apr;31(4):2461-2469. doi: 10.1245/s10434-023-14779-4. Epub 2023 Dec 23.
Real-world, long-term survival outcomes of neoadjuvant, docetaxel-based therapy for esophageal and junctional adenocarcinoma are lacking. This study describes the long-term survival outcomes of patients with esophageal and junctional adenocarcinoma treated with neoadjuvant docetaxel-based chemotherapy and en bloc transthoracic esophagectomy.
A retrospective cohort analysis of a prospectively maintained database from a regional upper gastrointestinal cancer network in Quebec, Canada, was performed. From January 2007 to December 2021, all patients with locally advanced (cT3 and/or N1) esophageal/Siewert I/II adenocarcinoma treated with neoadjuvant DCFx3 (Docetaxel/Cisplatin/5FU) or FLOTx4 (5FU/Leucovorin/Oxaliplatin/Docetaxel) and transthoracic en bloc esophagectomy were identified. Postoperative, pathological, and survival outcomes were compared.
Overall, 236 of 420 patients met the inclusion criteria. Tumor location was esophageal/Siewert I/Siewert II (118/33/85), most were cT3-4 (93.6%) and cN+ (61.0%). DCF and FLOT were used in 127 of 236 (53.8%) and 109 of 236 (46.2%). All neoadjuvant cycles were completed in 87.3% with no difference between the regimens. Operative procedures included Ivor Lewis (81.8%), left thoraco-abdominal esophagectomy (10.6%) and McKeown (7.6%) with an R0 resection in 95.3% and pathological complete response in 9.7% (DCF 12.6%/FLOT 6.4%, p = 0.111). The median lymph node yield was 32 (range 4-79), and 60.6% were ypN+. Median follow-up was longer for the DCF group (74.8 months 95% confidence interval [CI] 4-173 vs. 37.8 months 95% CI 2-119, p <0.001. Overall survival was similar between the groups (FLOT 97.3 months, 78.6-115.8 vs. DCF 92.9, 9.2-106.5, p = 0.420).
Neoadjuvant DCF and FLOT followed by transthoracic en bloc resection are both highly effective regimens for locally advanced esophageal adenocarcinoma with equivalent survival outcomes despite high disease load.
新辅助、基于多西紫杉醇的治疗在食管和食管胃结合部腺癌的真实世界、长期生存结果方面存在不足。本研究描述了接受新辅助多西紫杉醇为基础的化疗和整块经胸食管切除术治疗的食管和食管胃结合部腺癌患者的长期生存结果。
对加拿大魁北克地区一个区域上消化道癌症网络前瞻性维护数据库进行回顾性队列分析。从 2007 年 1 月至 2021 年 12 月，所有局部晚期（cT3 和/或 N1）食管/Siewert I/II 腺癌患者接受新辅助 DCFx3（多西紫杉醇/顺铂/5FU）或 FLOTx4（5FU/亚叶酸/奥沙利铂/多西紫杉醇）和整块经胸食管切除术治疗。比较术后、病理和生存结果。
总体而言，420 名患者中有 236 名符合纳入标准。肿瘤位置为食管/Siewert I/Siewert II（118/33/85），大多数为 cT3-4（93.6%）和 cN+（61.0%）。236 名患者中，127 名（53.8%）接受 DCF，109 名（46.2%）接受 FLOT。87.3%的患者完成了所有新辅助周期，两种方案之间无差异。手术方式包括 Ivor Lewis（81.8%）、左胸腹食管切除术（10.6%）和 McKeown（7.6%），95.3%的患者达到了 R0 切除，9.7%（DCF 12.6%/FLOT 6.4%，p=0.111）达到了病理完全缓解。中位淋巴结检出数为 32 个（范围 4-79 个），60.6%为 ypN+。DCF 组的中位随访时间更长（74.8 个月 95%CI 4-173 与 37.8 个月 95%CI 2-119，p<0.001）。两组总生存相似（FLOT 97.3 个月，78.6-115.8 与 DCF 92.9 个月，9.2-106.5，p=0.420）。
新辅助 DCF 和 FLOT 后行整块经胸食管切除术对局部晚期食管腺癌均为高度有效的治疗方案，尽管疾病负荷高，但生存结果相当。
