放化疗后临床完全缓解的食管鳞癌患者的主动监测。

Active surveillance for clinical complete responders after chemoradiotherapy for oesophageal squamous cell carcinoma.

机构信息

Department of General and Upper Gastrointestinal Surgery, University of Verona, Verona, Italy.

Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.

出版信息

Br J Surg. 2024 Jan 31;111(2). doi: 10.1093/bjs/znae036.

DOI:10.1093/bjs/znae036

PMID:38415879

Abstract

BACKGROUND

Guidelines on the treatment of oesophageal squamous cell carcinoma (SCC) recommend neoadjuvant chemoradiotherapy plus surgery or definitive chemoradiotherapy. The aim of this study was to evaluate the outcome of patients with a cCR after chemoradiotherapy who underwent active surveillance.

METHODS

Patients with oesophageal SCC who were treated with chemoradiotherapy between January 2016 and June 2022 were identified from an institutional database. Survival and recurrence of patients with a cCR who underwent active surveillance were compared with those of patients who underwent planned surgery. Survival was calculated according to the Kaplan-Meier method and compared between groups using the log rank test.

RESULTS

The 37 patients who underwent active surveillance were older and tumours were more often located in the middle/upper-third of the oesophagus than in the surgery group of 57 patients. Median follow-up was 28.1 (i.q.r. 17.2-47.1) months for the active surveillance group and 20 (12.9-39.1) months for the surgery group. Overall survival was comparable between the two groups, with 3-year survival rates of 50 (95% c.i. 31 to 67) and 59 (40 to 73)% for the active surveillance and surgery groups respectively (P = 0.55). Three-year progression-free survival for patients who underwent active surveillance was better than in the surgery group: 70 (43 to 85) versus 58 (40 to 72)% (P = 0.02). Overall and progression-free survival was comparable between patients in the active surveillance group and 23 patients in the surgery group who had a pCR (ypT0 N0). The overall recurrence rate was comparable between the groups: 7 of 37 (19.4%) in active surveillance group versus 16 of 49 (32.6%) in surgery group (P = 0.26). Locoregional recurrence was noted more often in the active surveillance group and systemic recurrence in the surgery group.

CONCLUSION

Active surveillance is feasible and safe for patients with oesophageal SCC who have a cCR after chemoradiotherapy.

摘要

背景

食管鳞状细胞癌（SCC）治疗指南建议新辅助放化疗加手术或根治性放化疗。本研究旨在评估接受放化疗后达到完全缓解（cCR）的患者接受主动监测的结果。

方法

从机构数据库中确定了 2016 年 1 月至 2022 年 6 月期间接受放化疗的食管 SCC 患者。比较 cCR 后接受主动监测的患者与计划接受手术的患者的生存和复发情况。根据 Kaplan-Meier 方法计算生存率，并使用对数秩检验比较组间差异。

结果

37 例接受主动监测的患者年龄较大，肿瘤位置较手术组的 57 例更常位于食管中/上段。主动监测组的中位随访时间为 28.1（IQR 17.2-47.1）个月，手术组为 20（12.9-39.1）个月。两组的总体生存率相当，主动监测组的 3 年生存率为 50（95%可信区间 31 至 67）%，手术组为 59（40 至 73）%（P = 0.55）。接受主动监测的患者 3 年无进展生存率优于手术组：70（43 至 85）% vs. 58（40 至 72）%（P = 0.02）。主动监测组和手术组 23 例达到病理完全缓解（ypT0 N0）的患者的总体和无进展生存率相当。两组的总复发率相当：主动监测组 37 例中有 7 例（19.4%），手术组 49 例中有 16 例（32.6%）（P = 0.26）。主动监测组更常见局部区域复发，手术组更常见全身复发。