Thomas P, Doddoli C, Lienne P, Morati N, Thirion X, Garbe L, Giudicelli R, Fuentes P
Department of Thoracic Surgery, Sainte Marguerite University Hospital, Marseilles, France.
Br J Surg. 1997 Jan;84(1):119-25.
Prognosis of oesophageal adenocarcinoma is notoriously dismal. To examine the changing patterns of and treatment strategies for this disease, the longitudinal experience of a single institution over 16 years is reported.
The study comprised a retrospective review of 551 consecutive patients operated on for oesophageal cancer between 1979 and 1995, of whom 164 had adenocarcinoma. There were 13 women and 151 men whose mean age was 61 (range 17-82) years.
The prevalence of adenocarcinoma (P = 0.002), that of early tumours (P < or = 0.10), and the resectability rate (P < or = 0.05) increased throughout the period whereas operative mortality rate decreased (P < or = 0.10). Surgical approach changed without influence on long-term survival. Patients referred from endoscopic surveillance programmes for Barrett's oesophagus (n = 16) had an improved survival rate compared with that of non-surveyed patients (P < or = 0.01). Overall 5-year survival after oesophagectomy (17 per cent) improved for the period 1991-1995 when compared with 1979-1982 (P < or = 0.02). Univariate analysis identified tumour node metastasis (TNM) stage, number of diseased lymph nodes, invasion of the oesophageal stump and occurrence of a postoperative complication as significant prognostic variables (P < or = 0.05). Multivariate analysis demonstrated that T stage (P = 0.0002) was the main independent predictor.
Recent improvement of results reflects patient selection, increased prevalence of early tumours, and dramatic reduction of the risks from oesophagectomy. New therapeutic directions should be investigated for locally advanced tumours.
众所周知，食管腺癌的预后很差。为研究这种疾病的变化模式和治疗策略，本文报告了一家机构16年的纵向经验。
本研究回顾性分析了1979年至1995年间连续接受食管癌手术的551例患者，其中164例为腺癌。患者包括13名女性和151名男性，平均年龄61岁（范围17 - 82岁）。
在此期间，腺癌的患病率（P = 0.002）、早期肿瘤的患病率（P≤0.10）和可切除率（P≤0.05）均有所上升，而手术死亡率下降（P≤0.10）。手术方式的改变对长期生存率没有影响。与未接受监测的患者相比，因巴雷特食管接受内镜监测计划转诊的患者（n = 16）生存率有所提高（P≤0.01）。与1979 - 1982年相比，1991 - 1995年食管切除术后的总体5年生存率（17%）有所提高（P≤0.02）。单因素分析确定肿瘤淋巴结转移（TNM）分期、受累淋巴结数量、食管残端侵犯和术后并发症的发生为显著的预后变量（P≤0.05）。多因素分析表明T分期（P = 0.0002）是主要的独立预测因素。
近期结果的改善反映了患者选择、早期肿瘤患病率的增加以及食管切除风险的显著降低。对于局部晚期肿瘤，应探索新的治疗方向。
