Multi-institutional Analysis of Recurrence and Survival After Neoadjuvant Chemoradiotherapy of Esophageal Cancer Impact of Histology on Recurrence Patterns and Outcomes
Multi-institutional Analysis of Recurrence and Survival After Neoadjuvant Chemoradiotherapy of Esophageal Cancer Impact of Histology on Recurrence Patterns and Outcomes
复制标题
DOI：
10.1097/sla.0000000000002670
复制
发表时间：
2019-04-01
影响因子：
9
通讯作者：
Lin, Steven H.
中科院分区：
文献类型：
--
作者：
Xi, Mian;Yang, Yadi;Lin, Steven H.
目的：探讨组织学对食管癌（EC）患者接受新辅助放化疗（CRT）的病理反应、生存结局和复发模式的影响。背景资料总结：关于食管鳞状细胞癌（SCC）和腺癌新辅助CRT后比较结果的数据缺乏。方法：回顾性分析2002 - 2015年3所学术机构行新辅助CRT +食管切除术的EC患者895例，其中SCC患者207例（23.1%），腺癌患者688例（76.9%）。比较两组患者的病理反应、生存率、复发模式及潜在预后因素。结果：SCC的病理完全缓解率（pCR）明显高于腺癌（44.9% vs 25.9%, P < 0.001）。中位随访52.9个月后，71例SCC患者（34.3%）和297例腺癌患者（43.2%）复发（P = 0.023）。对于达到pCR的患者，两组之间的复发模式、部位或生存终点没有显著差异。对于非pcr患者，SCC组表现出明显高于腺癌患者的区域和锁骨上复发率，但血液转移率低于腺癌患者，而腺癌患者具有更有利的局部区域无失败生存（P = 0.005）和更差的远处无转移生存（P = 0.024）。两组患者总生存率（P = 0.772）和无复发生存率（P = 0.696）均无差异。结论：SCC的pCR率明显高于腺癌。在非pcr患者中，两种组织学亚型之间的复发方式和生存结果存在显著差异。
Objective: To determine the impact of histology on pathologic response, survival outcomes, and recurrence patterns in patients with esophageal cancer (EC) who received neoadjuvant chemoradiotherapy (CRT).Summary of Background Data: There is a paucity of data regarding comparative outcomes after neoadjuvant CRT between esophageal squamous cell carcinoma (SCC) and adenocarcinoma.Methods: Between 2002 and 2015, 895 EC patients who underwent neoadjuvant CRT followed by esophagectomy at 3 academic institutions were retrospectively reviewed, including 207 patients with SCC (23.1%) and 688 patients with adenocarcinoma (76.9%). Pathologic response, survival, recurrence pattern, and potential prognostic factors were compared.Results: Pathologic complete response (pCR) rate was significantly higher for SCC compared with adenocarcinoma (44.9% vs 25.9%, P < 0.001). After a median follow-up of 52.9 months, 71 patients (34.3%) with SCC versus 297 patients (43.2%) with adenocarcinoma had recurrent disease (P = 0.023). For patients who achieved a pCR, no significant differences were found in recurrence pattern, sites, or survival end-points between the 2 histology groups. For non-pCR patients, the SCC group demonstrated significantly higher regional and supraclavicular recurrence rates but a lower hematogenous metastasis rate than adenocarcinoma patients, whereas the adenocarcinoma patients had a more favorable locoregional failure-free survival (P = 0.005) and worse distant metastasis-free survival (P = 0.024). No differences were found in overall survival (P = 0.772) or recurrence-free survival (P = 0.696) between groups.Conclusions: SCC was associated with a significantly higher pCR rate than adenocarcinoma. Recurrence pattern and survival outcomes were significantly different between the 2 histology subtypes in non-pCR patients.