食管鳞状细胞癌分期系统新辅助后I期的真实世界应用：病理完全缓解之外还有什么？
Real-world applications of postneoadjuvant stage I of the staging system for oesophageal squamous cell cancer: what is beyond a pathological complete response?
作者信息
Huang Yan, Li Zhichao, Wu Jiadi, Huang Sheng, Fang Caiyan, Li Kaiwen, Chen Jiyang, Su Huilin, Yang Hong, Luo Kongjia, Fu Jianhua
机构信息
Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Esophageal Cancer Institute, Collaborative Innovation Center for Cancer Medicine, Guangzhou City, Guangdong Province, China.
Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou City, Guangdong Province, China.
出版信息
Eur J Cardiothorac Surg. 2025 Jul 1;67(7). doi: 10.1093/ejcts/ezaf202.
OBJECTIVES
The 8th edition of the American Joint Committee on Cancer classification system defines the postneoadjuvant pathological T0-2N0M0 (ypT0-2N0M0) stage as ypI for oesophageal cancer. This study was designed to explore the possible differences in survival among patients with yp stage I.
METHODS
The records of patients with oesophageal squamous cell cancer staged ypI who underwent a radical oesophagectomy between July 2009 and July 2022 at the Sun Yat-sen University Cancer Center were reviewed. The survival differences were compared between ypT0, ypTis, ypT1a, ypT1b and ypT2.
RESULTS
A total of 355 patients (65 deaths and 34 recurrences) were reviewed. Overall survival (OS) and disease-free survival (DFS) differed significantly between patients in the total population staged as ypT0-1a and ypT1b-2 [5-year OS (5-OS): 81.5% vs 70.2%, P = 0.043; 5-year DFS (5-DFS): 80.8% vs 71.9%, P = 0.016) in the neoadjuvant chemoradiotherapy (NCRT) group (5-OS: 82.0% vs 67.5%, P = 0.032; 5-DFS: 84.6% vs 71.2%, P = 0.027), but not in the neoadjuvant chemotherapy±I group (5-OS: 80.3% vs 72.9%, P = 0.34; 5-DFS: 66.5% vs 72.4%, P = 0.41). The OS and DFS of patients with ypT0 stage (pathological complete response) disease were similar to those of patients with ypTis-1a disease in the total population (P = 0.16 and 0.94) and the NCRT group (P = 0.40 and 0.57). Cox regression analysis revealed that ypT1b-2 was an independent prognostic factor for survival in the total population (hazard ratio = 1.760, 95% confidence interval = 1.056-2.933; P = 0.030).
CONCLUSIONS
Patients with ypIa-new (ypT0-1aN0M0) disease had significantly better survival than those with ypIb-new (ypT1b-2N0M0) disease among patients who received NCRT. Patients with ypIa-new (pathological complete response and ypTis-1aN0M0) disease had similar survival data. Adjuvant immunotherapy might not be required for patients with ypTis-1aN0M0 stage disease.
目的
美国癌症联合委员会第8版分类系统将食管癌新辅助治疗后的病理T0 - 2N0M0（ypT0 - 2N0M0）期定义为ypI期。本研究旨在探讨ypI期患者生存情况的可能差异。
方法
回顾了2009年7月至2022年7月在中山大学肿瘤防治中心接受根治性食管切除术的ypI期食管鳞状细胞癌患者的记录。比较了ypT0、ypTis、ypT1a、ypT1b和ypT2患者的生存差异。
结果
共纳入355例患者（65例死亡，34例复发）。新辅助放化疗（NCRT）组中，ypT0 - 1a期和ypT1b - 2期患者的总生存期（OS）和无病生存期（DFS）存在显著差异[5年总生存期（5 - OS）：81.5%对70.2%，P = 0.043；5年无病生存期（5 - DFS）：80.8%对71.9%，P = 0.016]，而新辅助化疗±免疫组无差异（5 - OS：80.3%对72.9%，P = 0.34；5 - DFS：66.5%对72.4%，P = 0.41）。ypT0期（病理完全缓解）患者的OS和DFS与总体人群及NCRT组中ypTis - 1a期患者相似（P分别为0.16和0.94；P分别为0.40和0.57）。Cox回归分析显示，ypT1b - 2是总体人群生存的独立预后因素（风险比 = 1.760，95%置信区间 = 1.056 - 2.933；P = 0.030）。
结论
在接受NCRT的患者中，ypIa新（ypT0 - 1aN0M0）期疾病患者的生存明显优于ypIb新（ypT1b - 2N0M0）期疾病患者。ypIa新（病理完全缓解和ypTis - 1aN0M0）期疾病患者的生存数据相似。ypTis - 1aN0M期疾病患者可能不需要辅助免疫治疗。
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