Vogel S B, Mendenhall W M, Sombeck M D, Marsh R, Woodward E R
Department of Surgery, University of Florida, College of Medicine, Gainesville, USA.
Ann Surg. 1995 Jun;221(6):685-93; discussion 693-5. doi: 10.1097/00000658-199506000-00008.
This retrospective, nonrandomized review evaluates 125 patients with esophageal carcinoma (adenocarcinoma and squamous cell) who underwent either surgery only or preoperative chemotherapy and/or radiation therapy followed by surgery. Major end points were survival and postchemoradiation downstaging.
Forty-four patients underwent radiation therapy of 4500 cGy over 5 weeks. Fluorouracil and cisplatin were administered on the first and fifth week of radiotherapy. Ninety-eight patients underwent "potentially curative" resections-transhiatal esophagectomy (70), Lewis esophagogastrectomy (25), and left esophagogastrectomy (3). All patients with preoperative adjuvant therapy underwent endoscopy and biopsy before surgery.
There were no differences in overall mortality (5%) or surgical complications in either group. Fourteen of 44 patients (32%) downstaged to complete pathologic response, with 5-year survival of 57%. Fifteen of 44 patients (34%) downstaged to microscopic residual tumor, with 1- and 3-year survival of 77% and 31%, respectively. Twenty-eight of 29 patients in the two downstaged groups were lymph node negative. Overall, 5-year survival in the adjuvant therapy plus surgery group versus surgery only was 36% and 11% (p = 0.04). Five-year survival in lymph node-negative adjuvant therapy and surgery patients was 49% (p = 0.005). Positive nodes in the surgery only group was 48% versus 23% in the adjuvant therapy and surgery group (p = 0.02).
Although retrospective and nonrandomized, these results suggest that preoperative chemoradiation results in significant clinical and pathologic downstaging, increases survival, and may sterilize local and regional lymph nodes, accounting for both downstaging and survival statistics.
本回顾性、非随机研究评估了125例食管癌（腺癌和鳞状细胞癌）患者，这些患者要么仅接受手术治疗，要么先接受术前化疗和/或放疗，然后再进行手术。主要终点是生存率和放化疗后的降期情况。
44例患者在5周内接受了4500 cGy的放射治疗。在放疗的第一周和第五周给予氟尿嘧啶和顺铂。98例患者接受了“潜在根治性”切除术——经胸食管切除术（70例）、Lewis食管胃切除术（25例）和左食管胃切除术（3例）。所有接受术前辅助治疗的患者在手术前均接受了内镜检查和活检。
两组的总死亡率（5%）或手术并发症方面均无差异。44例患者中有14例（32%）降期至完全病理缓解，5年生存率为57%。44例患者中有15例（34%）降期至微小残留肿瘤，1年和3年生存率分别为77%和31%。两个降期组的29例患者中有28例淋巴结阴性。总体而言，辅助治疗加手术组与单纯手术组的5年生存率分别为36%和11%（p = 0.04）。淋巴结阴性的辅助治疗和手术患者的5年生存率为49%（p = 0.005）。单纯手术组的阳性淋巴结率为48%，而辅助治疗和手术组为23%（p = 0.02）。
尽管本研究为回顾性且非随机，但这些结果表明术前放化疗可导致显著的临床和病理降期，提高生存率，并可能使局部和区域淋巴结失活，这解释了降期情况和生存统计结果。
