Neoadjuvant chemotherapy followed by minimally invasive esophagectomy versus primary surgery for management of esophageal carcinoma: a retrospective study
Neoadjuvant chemotherapy followed by minimally invasive esophagectomy versus primary surgery for management of esophageal carcinoma: a retrospective study
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DOI：
10.7150/jca.29353
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发表时间：
2019-01-01
影响因子：
3.9
通讯作者：
Liu, Shilei
中科院分区：
文献类型：
--
作者：
Zheng, Yan;Li, Yin;Liu, Shilei
对于食管鳞癌的综合治疗策略，中国并没有达成共识。在过去的新辅助化疗试验中，手术程序的质量控制和标准化程度远远不能令人满意，这可能低估了患者的生存益处。因此，我们试图评估紫杉醇加铂加微创全二野淋巴清扫术与初次手术相比的生存益处。在2011年6月至2014年12月期间，279名患者接受了微创食道切除加两野全淋巴结清扫；83名患者接受了新辅助化疗，196名患者接受了初次手术。采用倾向评分匹配的方法对新辅助化疗患者和76例匹配的初次手术患者进行比较。评估新辅助化疗的疗效、不良反应、术后并发症和生存率。在倾向评分匹配后，与初次手术相比，新辅助化疗与较好的生存期显著相关(P=0.049)。新辅助化疗总有效率为77.1%。病理有效率为20.5%。两组并发症发生率差异无统计学意义。紫杉醇+铂类新辅助化疗加微创食道切除术和两野全淋巴结清扫术较一期手术有更好的手术疗效，且无严重不良反应。
There is no consensus about the combined therapeutic strategy for esophageal squamous cell carcinoma in China. The quality control and standardization of surgery procedures were far from satisfactory in past neoadjuvant chemotherapy trials, which may underestimate the survival benefits. Therefore, we tried to evaluate the survival benefit of paclitaxel plus platinum followed by minimally invasive esophagectomy with total two-field lymphadenectomy patterns versus primary surgery. Between 06/2011 and 12/2014, there were 279 consecutive patients who underwent minimally invasive esophagectomy with total two-field lymphadenectomy; 83 received neoadjuvant chemotherapy and 196 primary surgery. Propensity score matching was used to compare neoadjuvant chemotherapy patients and 76 matched primary surgery patients. Effectiveness of neoadjuvant chemotherapy, adverse events, complications after the operation, and survival rates were evaluated. After propensity score matching, and compared with primary surgery, neoadjuvant chemotherapy was significantly associated with a better survival (P = 0.049). The overall clinical response rate of neoadjuvant chemotherapy was 77.1%. The pathological response rate was 20.5%. There was no significant difference in complication rates between two groups. Neoadjuvant chemotherapy with paclitaxel plus platinum followed by minimally invasive esophagectomy and total two-field lymphadenectomy have better OS over the primary surgery without serious adverse events.