Clinical significance of the second cycle response to cisplatin-based chemotherapy as preoperative treatment for esophageal squamous cell carcinoma
Clinical significance of the second cycle response to cisplatin-based chemotherapy as preoperative treatment for esophageal squamous cell carcinoma
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DOI：
10.1002/jso.20501
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发表时间：
2006-04-01
影响因子：
2.5
通讯作者：
Imaoka, S
中科院分区：
文献类型：
--
作者：
Akita, H;Doki, Y;Imaoka, S
背景：以顺铂为基础的两个周期重复化疗是晚期食管鳞癌(ESCC)术前治疗的标准方案。方法：46例晚期食管癌患者接受了2个周期(41个周期)或1个周期(5个周期)的化疗，包括顺铂、阿霉素和5-氟尿嘧啶(5-FU)，然后进行手术。结果：第一周期和第二周期的肿瘤缩小率(RR)分别为33.3+/-22.5%和11.5+/-42.6%，第二周期的有效率较低，偏差较大。第二周期RR与手术标本的病理结果(包括化疗效果、肿瘤深度、淋巴结转移)及术后生存率密切相关，3年时疗效好者为75.2%，反应差者为26.8%(P=0.0028)。第一周期RR与上述两项指标均无相关性。在多因素分析中，第二周期RR是唯一独立的预后因素。结论：第二周期顺铂为主的化疗方案对食管癌的疗效较差，但与术后生存率的关系更为密切。对于对第二周期化疗耐药的食管鳞癌，应考虑手术以外的治疗。
Background: Repeating two cycles of cisplatin-based chemotherapy is standard protocol for preoperative treatment for advanced esophageal squamous cell carcinoma (ESCC). However, the second cycle of chemotherapy is often less effective than the first.Methods: Forty-six patients with advanced ESCC underwent two (4 1) or one (5) cycle of chemotherapy, consisting of cisplatin, adriamycin, and 5-fluorouracil (5-FU), followed by surgery.Results: The tumor reduction rates (RR) for the first and second cycles of chemotherapy were 33.3 +/- 22.5% versus 11.5 +/- 42.6%, with the second showing less effectiveness and larger deviation. The second cycle RR was closely correlated with the pathological findings of the surgical specimens, including the effect of chemotherapy, tumor depth, and lymph node metastases, and with postoperative survival rates, which were 75.2% and 26.8% (P = 0.0028) at 3 years for good and poor responders. The first cycle RR showed correlation with neither. The second cycle RR was the only independent prognostic factor among the preoperative parameters in multivariate analysis.Conclusions: The second cycle of cisplatin-based chemotherapy in ESCC is less effective, but more closely related with postoperative survival than the first. Treatment other than Surgery should be considered for ESCC resistant to second cycle chemotherapy.