Deeb Ashley L, Dezube Aaron R, Lozano Antonio, Singh Anupama, De Leon Luis E, Kucukak Suden, Jaklitsch Michael T, Wee Jon O
Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Boston University School of Medicine, Boston, MA, USA.
J Thorac Dis. 2024 Sep 30;16(9):5615-5623. doi: 10.21037/jtd-24-316. Epub 2024 Sep 21.
Neoadjuvant chemoradiation therapy (nCRT) followed by esophagectomy is the standard treatment for resectable, locally advanced esophageal cancer. The ideal timing between neoadjuvant therapy and esophagectomy is unclear. Delayed esophagectomy is associated with worse outcomes. We investigated which factors impacted time to esophagectomy in our patients.
We conducted a retrospective analysis of prospectively collected data of patients with pT0-3N0-2 esophageal cancers who underwent CROSS trimodality therapy from May 2016 to January 2020. Sociodemographic factors, comorbidities, and neoadjuvant factors (location of CRT, treatment toxicity, discontinuation of treatment) were compared between patients who underwent surgery within 60 days and those after 60 days.
In total, 197 patients were analyzed of whom 137 underwent esophagectomy within 60 days (early surgery, ES) and 60 were outside that window (delayed surgery, DS). More DS patients had a history of myocardial infarction (MI) or stroke (both 11.67% 3.65%, P=0.05) and required CRT dose reduction (16.67% 6.57%, P=0.04). Fewer DS patients received CRT at Dana-Farber Cancer Institute (DFCI) or a DFCI satellite site (33.33% 58.4%, P=0.01) and saw our surgeons before CRT completion (68.33% 89.78%, P=0.001). CRT at DFCI [odds ratio (OR) 2.63, P=0.01] or a satellite site (OR 3.07, P=0.01) and evaluation by a thoracic surgeon (OR 4.07, P=0.001) shortened time to esophagectomy. History of MI (OR 0.29, P=0.04), stroke (OR 0.29, P=0.04), and CRT dose reduction (OR 0.35, P=0.03) delayed time to esophagectomy.
Improving access to multispecialty cancer centers and increasing satellite sites may improve time to esophagectomy.
新辅助放化疗（nCRT）后行食管切除术是可切除的局部晚期食管癌的标准治疗方法。新辅助治疗与食管切除术之间的理想时间尚不清楚。延迟食管切除术与更差的预后相关。我们调查了哪些因素影响了我们患者的食管切除时间。
我们对2016年5月至2020年1月接受CROSS三联疗法的pT0-3N0-2食管癌患者的前瞻性收集数据进行了回顾性分析。比较了在60天内接受手术的患者和60天后接受手术的患者的社会人口统计学因素、合并症和新辅助因素（CRT的位置、治疗毒性、治疗中断）。
总共分析了197例患者，其中137例在60天内接受了食管切除术（早期手术，ES），60例在该时间窗之外（延迟手术，DS）。更多的DS患者有心肌梗死（MI）或中风病史（均为11.67%对3.65%，P=0.05），并且需要降低CRT剂量（16.67%对6.57%，P=0.04）。较少的DS患者在达纳-法伯癌症研究所（DFCI）或DFCI卫星站点接受CRT（33.33%对58.4%，P=0.01），并且在CRT完成前见到我们的外科医生（68.33%对89.78%，P=0.001）。在DFCI（比值比[OR]2.63，P=0.01）或卫星站点（OR 3.07，P=0.01）进行CRT以及由胸外科医生进行评估（OR 4.07，P=0.001）缩短了食管切除时间。MI病史（OR 0.29，P=0.04）、中风病史（OR 0.29，P=0.04）和CRT剂量降低（OR 0.35，P=0.03）延迟了食管切除时间。
改善进入多专科癌症中心的机会并增加卫星站点可能会缩短食管切除时间。
