Department of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata City, Osaka, 573-1010, Japan.
Department of Surgery, Kindai University Nara Hospital, Nara, Japan.
Esophagus. 2024 Oct;21(4):472-483. doi: 10.1007/s10388-024-01070-y. Epub 2024 Aug 22.
The association between recurrence timing and prognosis in patients with locally advanced resectable esophageal cancer undergoing neoadjuvant chemotherapy (NAC) followed by esophagectomy remains unclear. This study aimed to clarify this association using multicenter prospective clinical trial data.
Among 162 patients enrolled in a NAC phase II study comparing the efficacy of cisplatin and fluorouracil plus docetaxel with cisplatin and fluorouracil plus adriamycin, 64 patients with recurrence after R0 resection were included in this study. We evaluated the association between recurrence timing and overall survival after recurrence (OSr), along with clinicopathological factors associated with recurrence timing and OSr.
Among 64 patients, 46 (71.9%) and 59 (92.2%) experienced recurrence within 1 and 2 years after surgery, respectively. Groups based on recurrence timing, including ≤ 6, 6-12, and > 12 months, had median OSr of 3.6, 13.9, and 13.4 months, respectively. The prognosis was significantly poorer for patients with recurrence ≤ 6 months after surgery than for other patients (P < 0.001). Multivariate analysis revealed pathological lymph node staging as an independent factor associated with early recurrence (odds ratio: 3.46, 95% confidence interval: 1.47-8.02, P = 0.0045). On the other hand, multivariate analysis for factors associated with OSr revealed pT (hazard ratio [HR]: 1.91, 95%CI 1.26-2.88, P = 0.0022), early recurrence (HR: 6.88, 95%CI 2.68-17.6, P < 0.001), and treatment after recurrence, with both local treatment (HR: 0.47, 95%CI 0.22-0.98, P = 0.043) and chemotherapy (HR: 0.25, 95%CI 0.11-0.58, P = 0.0011) as independent prognostic factors.
Patients with advanced esophageal cancer experiencing recurrence within 6 months after esophagectomy following NAC have an extremely poor prognosis, suggesting that an advanced pN stage is associated with early recurrence.
接受新辅助化疗（NAC）后行食管切除术的局部晚期可切除食管癌患者，其复发时间与预后之间的关系尚不清楚。本研究旨在使用多中心前瞻性临床试验数据阐明这种相关性。
在一项 NAC Ⅱ期研究中，共有 162 名患者入组，比较顺铂和氟尿嘧啶加多西他赛与顺铂和氟尿嘧啶加阿霉素的疗效，其中 64 名患者在 R0 切除术后复发。我们评估了复发时间与复发后总生存期（OSr）之间的关系，以及与复发时间和 OSr 相关的临床病理因素。
在 64 名患者中，46 名（71.9%）和 59 名（92.2%）分别在手术后 1 年和 2 年内复发。根据复发时间分组，包括≤6 个月、6-12 个月和>12 个月，中位 OSr 分别为 3.6、13.9 和 13.4 个月。与其他患者相比，术后 6 个月内复发的患者预后明显较差（P<0.001）。多变量分析显示，病理淋巴结分期是与早期复发相关的独立因素（优势比：3.46，95%置信区间：1.47-8.02，P=0.0045）。另一方面，与 OSr 相关的多变量分析显示，pT（风险比 [HR]：1.91，95%CI 1.26-2.88，P=0.0022）、早期复发（HR：6.88，95%CI 2.68-17.6，P<0.001）和治疗后复发，局部治疗（HR：0.47，95%CI 0.22-0.98，P=0.043）和化疗（HR：0.25，95%CI 0.11-0.58，P=0.0011）均为独立的预后因素。
接受新辅助化疗后行食管切除术的晚期食管癌患者在术后 6 个月内复发的患者预后极差，提示进展期 pN 期与早期复发相关。
