Complete response to neoadjuvant chemoradiotherapy in esophageal carcinoma is associated with significantly improved survival
Complete response to neoadjuvant chemoradiotherapy in esophageal carcinoma is associated with significantly improved survival
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DOI：
10.1200/jco.2005.05.017
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发表时间：
2005-07-01
影响因子：
45.3
通讯作者：
Goldberg, M
中科院分区：
文献类型：
--
作者：
Berger, AC;Farma, J;Goldberg, M
目的：通过诱导放化疗（CRT）和手术治疗来提高食管癌患者的生存率。方法回顾1994年1月至2002年12月间行食管切除术的所有患者，采用对数秩和考克斯比例风险模型进行单因素和多因素分析，结果171例浸润性癌患者中，131例（77%）术前接受了CRT治疗。平均年龄为60岁，大多数患者为男性（85%）。手术包括Ivor-Lewis（60%）、经裂孔（8%）、三孔（23%）或左胸腹（8%）食管切除术。围手术期死亡率为5%。整个组的中位总生存期（OS）为33个月，5年OS率为26%。诱导CRT的5年生存率为33%，而单纯手术的5年生存率为11%（P = 0.43）。与未降级的患者相比，降级至病理分期0或I的患者的OS和无病生存率（DFS）有所改善（P = 0.022）。此外，进行RO切除的能力是OS和DFS的重要因素（n = 130;分别为P < .0001和P < .0002）。结论CRT的反应和进行RO切除的能力与食管癌患者生存率的显著提高相关。(c)2005年，美国临床肿瘤学会。
Purpose Attempts to improve survival of patients with esophageal cancer have been made using induction chemoradiotherapy (CRT) followed by surgery. A large single-center experience was reviewed to determine which treatment-related variables could predict survival and recurrence.Patients and Methods All patients undergoing esophagectomy between January 1994 and December 2002 were reviewed, Univariate and multivariate analyses were performed using log-rank and Cox proportional hazards models, and survival curves were estimated using the Kaplan-Meier method.Results Of 171 patients with invasive cancer, 131 (77%) underwent preoperative CRT. The average age was 60 years, and most patients were male (85%). Operations performed included Ivor-Lewis (60%), transhiatal (8%), three-hole (23%), or left thoracoabdominal (8%) esophagectomy. Perioperative mortality rate was 5%. Median overall survival (OS) of the entire group was 33 months, and the 5-year OS rate was 26%. Induction CRT was associated with a 33% 5-year survival rate compared with 11% for surgery alone (P = .43), Patients downstaged to pathologic stage 0 or I had an improved OS and disease-free survival (DFS) compared with those patients who were not downstaged (P = .022). Additionally, the ability to perform an R0 resection was a significant factor for OS and DFS (n = 130; P < .0001 and P < .0002, respectively).Conclusion Response to CRT and the ability to perform an RO resection are associated with significantly improved survival in patients with esophageal carcinoma. (c) 2005 by American Society of Clinical Oncology.