SURVIVAL AFTER ADJUVANT CHEMORADIOTHERAPY OR SURGERY ALONE IN RESECTABLE ADENOCARCINOMA AT THE GASTRO-ESOPHAGEAL JUNCTION
SURVIVAL AFTER ADJUVANT CHEMORADIOTHERAPY OR SURGERY ALONE IN RESECTABLE ADENOCARCINOMA AT THE GASTRO-ESOPHAGEAL JUNCTION
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DOI：
10.1177/145749691210100106
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发表时间：
2012-01-01
影响因子：
2.4
通讯作者：
Svendsen, L. B.
中科院分区：
文献类型：
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作者：
Kofoed, S. C.;Muhic, A.;Svendsen, L. B.
背景和目的：胃食管交界处（GEJ）腺癌根治性切除术后的长期生存率在18%到50%之间。在Macdonald等人进行的关键性Inter-group-0116 III期试验中，辅助放化疗改善了以胃腺癌为主的根治性切除患者的无病生存期和总生存期。我们比较了生存数据根治性切除腺癌患者单独在胃食管交界处（GEJ），单独手术或手术和辅助放化疗治疗。方法：从2003年至2009年，211例患者进行根治性切除。95例患者仅行手术治疗，116例患者在切除后接受辅助治疗。所有患者均行Lewis-Tanner手术，切除D1淋巴结，包括结肠淋巴结（D1+）。有关复发和死亡的信息收集自丹麦癌症登记处和中央死亡登记处。术后发生严重并发症后死亡的患者被排除在生存分析之外。T0 N 0或T1 N 0患者也被排除在外，因为根据麦克唐纳方案，此类患者未接受辅助治疗。结果：切除标本中淋巴结状态呈阳性的患者，辅助放化疗（n = 91）或单纯手术（n = 43）后的3年无病生存率分别为24%和37%。中位生存期延长10个月，有利于那些接受放化疗。然而，在控制了年龄和淋巴结状态的混杂效应后，只有切除标本中的阳性淋巴结状态对生存率有显著的部分影响。结论：根据Intergroup-0116协议的放化疗可能仍然是一个合理的选择，在GEJ腺癌和阳性淋巴结状态，谁没有接受新辅助化疗的患者根治性切除术后。
Background and Aims: Longterm survival after curative resection for adenocarcinoma at the gastro-esophageal junction (GEJ) range between 18% and 50%. In the pivotal Inter-group-0116 Phase III trial by Macdonald et all, adjuvant chemoradiotherapy improved both disease-free and overall survival in curatively resected patients with mainly gastric adenocarcinoma. We compared survival data for curatively resected patients with adenocarcinoma solely at the gastro-esophageal junction (GEJ), treated with surgery alone or surgery and adjuvant chemoradiotherapy.Methods: From 2003 to 2009, 211 patients underwent curative resection. Surgery alone was performed in 95 patients and 116 patients received adjuvant therapy after resection. All patients underwent Lewis-Tanner operation with D1 node resection including coliac nodes (D1+). Informations about recurrence and death were collected from the Danish Cancer Register and the Central Death Register. Patients who died after experiencing severe complications after surgery were excluded from the survival analysis. Patients with T0N0 or T1N0 were also excluded because patients of this category were not given adjuvant therapy according to the Macdonald protocol.Results: Patients with positive node status in the resected specimen, the 3-year disease-free survival after adjuvant chemoradiotherapy (n = 91) or surgery alone (n = 43) was 24% and 37%, respectively. Median time of survival was prolonged by 10 month in favour of those who received chemoradiotherapy. However, after controlling for the confounding effect of age and node status, only positive node status in the resected specimen had significant partial effect on survival.Conclusion: Chemoradiotherapy according to the Intergroup-0116 protocol might still be a reasonable option after curative resection in patients with GEJ adenocarcinomas and positive lymph node status, who did not receive neoadjuvant chemotherapy.