新辅助化疗和手术治疗局部晚期食管鳞癌后残留病理疾病患者辅助化疗的生存获益。

Survival benefits of adjuvant chemotherapy for patients with residual pathologic disease after neoadjuvant chemotherapy and surgery for locally advanced esophageal squamous cell carcinoma.

机构信息

Department of Thoracic Surgery, Fourth Hospital, Hebei Medical University, Shijiazhuang, China.

出版信息

J Gastrointest Surg. 2024 Jun;28(6):867-869. doi: 10.1016/j.gassur.2024.03.016. Epub 2024 Mar 16.

DOI:10.1016/j.gassur.2024.03.016

PMID:38570232

Abstract

BACKGROUND

Although preoperative neoadjuvant chemotherapy (NACT) or chemoradiation is the current standard of care for esophageal cancer in China, the impact of subsequent adjuvant therapy on patient prognosis remains unknown. This study aims to analyze the effect of adjuvant chemotherapy (ACT) on the survival rates of patients who have achieved a non-pathological complete response (non-pCR) after NACT and subsequent surgery.

METHODS

We reviewed the data of 2193 patients with locally advanced thoracic esophageal squamous cell carcinoma (ESCC) who underwent radical surgery between January 2006 and January 2016. Of these patients, 46 received NACT and ACT, while 109 received NACT only. Propensity score matching was used to compare 86 patients, with 43 patients in the NACT + ACT group and 43 patients in the NACT group. Univariate analysis was performed using the Kaplan-Meier method and log-rank test, while Cox regression analysis was used for multivariate analysis.

RESULTS

Multivariate analysis revealed that pathological lymph node status (positive vs negative) (P < .001) and treatment modalities (NACT + ACT vs NACT) (P = .005) were independent prognostic factors. There was a significant difference in long-term survival rates between the NACT + ACT and NACT groups, with 5-year survival rates of 55.8% vs 39.5%, respectively (χ = 4.270, P = .039). In patients with ypN status, the 5-year survival rate was 31.8% for those who received ACT after NACT and surgery, compared to 10.0% for those who did not receive additional ACT (χ = 6.101, P = .014). The corresponding percentages in patients with ypN were 81.0% and 65.2%, respectively (χ = 1.993, P = .158).

CONCLUSION

Adjuvant chemotherapy should be recommended for locally advanced ESCC patients with residual cancer after NACT and surgery, especially for patients with nodal metastases after NACT.

摘要

背景

尽管术前新辅助化疗（NACT）或放化疗是目前中国食管癌的标准治疗方法，但后续辅助治疗对患者预后的影响仍不清楚。本研究旨在分析 NACT 及随后手术治疗后非病理完全缓解（non-pCR）患者接受辅助化疗（ACT）的生存获益。

方法

我们回顾了 2006 年 1 月至 2016 年 1 月期间接受根治性手术的局部晚期胸段食管鳞癌（ESCC）患者 2193 例的临床资料。其中，46 例患者接受了 NACT 和 ACT，109 例患者仅接受了 NACT。采用倾向性评分匹配比较了 86 例患者，其中 NACT+ACT 组 43 例，NACT 组 43 例。采用 Kaplan-Meier 法和 log-rank 检验进行单因素分析，采用 Cox 回归分析进行多因素分析。

结果

多因素分析显示，病理淋巴结状态（阳性 vs 阴性）（P<.001）和治疗方式（NACT+ACT 与 NACT）（P=.005）是独立的预后因素。NACT+ACT 组和 NACT 组的长期生存率有显著差异，5 年生存率分别为 55.8%和 39.5%（χ²=4.270，P=.039）。在 ypN 状态患者中，NACT 及手术治疗后接受 ACT 的患者 5 年生存率为 31.8%，未接受额外 ACT 的患者为 10.0%（χ²=6.101，P=.014）。ypN 阳性患者的相应比例分别为 81.0%和 65.2%（χ²=1.993，P=.158）。