Long-term outcomes following neoadjuvant chemoradiotherapy for esophageal cancer
Long-term outcomes following neoadjuvant chemoradiotherapy for esophageal cancer
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DOI：
10.1097/01.sla.0000254367.15810.38
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发表时间：
2007-05-01
影响因子：
9
通讯作者：
Murphy, Thomas J.
中科院分区：
文献类型：
--
作者：
Reynolds, John Vincent;Muldoon, Cian;Murphy, Thomas J.
目的：我们提出并分析了食管癌多模式治疗后的长期结果，特别是组织形态学肿瘤消退和淋巴结状态的相对影响。患者和方法：共243名患者[（腺癌（n = 170）和鳞状细胞癌（n = 73）]对1990年至2004年期间接受新辅助放化疗治疗的患者进行了前瞻性随访，中位随访时间为60个月。记录病理分期和肿瘤消退分级（TRG），记录首次失败的部位，绘制Kaplan-Meier生存曲线。结果：30例（12%）患者因疾病进展或体力状态恶化而未行手术。41例患者（19%）有完全病理学缓解（pCR），其中31例（15%）为I期，69例（32%）为II期，72例（34%）为III期。总中位生存期为18个月，5年生存率为27%。达到pCR的患者的5年生存率为50%，而淋巴结阴性的非pCR患者为37%（P = 0.86）。组织形态学肿瘤消退与CRT前cTN分期无关，但与ypN分期显著相关（P < 0.05）。多因素分析显示，ypN分期（P = 0.002）较TRG分期（P = 0.06）和ypT分期（P = 0.39）更能预测总生存率。组织形态学肿瘤消退对预后的预测性低于病理学淋巴结状态（ypN），在新的分期分类中是否需要包括原发部位消退评分尚不清楚。
Objective: We present and analyze long-term outcomes following multimodal therapy for esophageal cancer, in particular the relative impact of histomorphologic tumor regression and nodal status.Patients and Methods: A total of 243 patients [(adenocarcinoma (n = 170) and squamous cell carcinoma (n = 73)] treated with neoadjuvant chemoradiotherapy in the period 1990 to 2004 were followed prospectively with a median follow-up of 60 months. Pathologic stage and tumor regression grade (TRG) were documented, the site of first failure was recorded, and Kaplan-Meier survival curves were plotted.Results: Thirty patients (12%) did not undergo surgery due to disease progression or deteriorated performance status. Forty-one patients (19%) had a complete pathologic response (pCR), and there were 31(15%) stage I, 69 (32%) stage II, and 72 (34%) stage III cases. The overall median survival was 18 months, and the 5-year survival was 27%. The 5-year survival of patients achieving a pCR was 50% compared with 37% in non-pCR patients who were node-negative (P = 0.86). Histomorphologic tumor regression was not associated with pre-CRT cTN stage but was significantly (P < 0.05) associated with ypN stage. By multivariate analysis, ypN status (P = 0.002) was more predictive of overall survival than TRG (P = 0.06) or ypT stage (P = 0.39).Conclusion: Achieving a node-negative status is the major determinant of outcome following neoadjuvant chemoradiotherapy. Histomorphologic tumor regression is less predictive of outcome than pathologic nodal status (ypN), and the need to include a primary site regression score in a new staging classification is unclear.