Ten-Year Outcome of Neoadjuvant Chemoradiotherapy Plus Surgery for Esophageal Cancer: The Randomized Controlled CROSS Trial
Ten-Year Outcome of Neoadjuvant Chemoradiotherapy Plus Surgery for Esophageal Cancer: The Randomized Controlled CROSS Trial
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DOI：
10.1200/jco.20.03614
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发表时间：
2021-06-20
影响因子：
45.3
通讯作者：
van der Gaast, Ate
中科院分区：
文献类型：
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作者：
Eyck, Ben M.;van Lanschot, J. Jan B.;van der Gaast, Ate
根据食管癌手术后放化疗研究（CROSS），术前放化疗已成为局部晚期可切除食管癌或交界区癌患者的标准治疗。我们的目的是评估这种方案的长期结果。方法：从2004年到2008年，我们将366例患者随机分为两组，一组接受卡铂和紫杉醇联合放疗（41.4戈伊，23次，每周5天），每周5个周期，随后进行手术，另一组仅接受手术。随访数据收集至2018年。采用考克斯回归分析比较总生存率、病因特异性生存率以及局部复发和远处复发的风险。采用时间依赖性考克斯回归和界标分析对5年随访后新辅助放化疗的效果进行了检验。结果中位随访时间为147个月（四分位距，134-157）。接受新辅助放化疗的患者总生存率更高（风险比[HR]，0.70; 95% CI，0.55 - 0.89）。新辅助放化疗对总生存率的影响不具有时间依赖性（相互作用的P值，P = 0.73），里程碑分析表明，对总生存率的影响稳定至10年随访。绝对10年总生存率获益为13%（38% vs 25%）。新辅助放化疗可降低食管癌死亡风险（HR，0.60; 95% CI，0.46 - 0.80）。研究组间其他原因导致的死亡相似（HR，1.17; 95% CI，0.68 - 1.99）。尽管对孤立性局部复发（HR，0.40; 95% CI，0.21 - 0.72）和同步性局部复发加远处复发（HR，0.43; 95% CI，0.26 - 0.72）的明显影响持续存在，但孤立性远处复发具有可比性（HR，0.76; 95% CI，0.52 - 1.13）。结论根据CROSS标准，术前放化疗对局部晚期食管癌或交界区癌患者的总体生存益处至少持续10年。
PURPOSE Preoperative chemoradiotherapy according to the chemoradiotherapy for esophageal cancer followed by surgery study (CROSS) has become a standard of care for patients with locally advanced resectable esophageal or junctional cancer. We aimed to assess long-term outcome of this regimen. METHODS From 2004 through 2008, we randomly assigned 366 patients to either five weekly cycles of carboplatin and paclitaxel with concurrent radiotherapy (41.4 Gy in 23 fractions, 5 days per week) followed by surgery, or surgery alone. Follow-up data were collected through 2018. Cox regression analyses were performed to compare overall survival, cause-specific survival, and risks of locoregional and distant relapse. The effect of neoadjuvant chemoradiotherapy beyond 5 years of follow-up was tested with time-dependent Cox regression and landmark analyses. RESULTS The median follow-up was 147 months (interquartile range, 134-157). Patients receiving neoadjuvant chemoradiotherapy had better overall survival (hazard ratio [HR], 0.70; 95% CI, 0.55 to 0.89). The effect of neoadjuvant chemoradiotherapy on overall survival was not time-dependent (P value for interaction, P = .73), and landmark analyses suggested a stable effect on overall survival up to 10 years of follow-up. The absolute 10-year overall survival benefit was 13% (38% v 25%). Neoadjuvant chemoradiotherapy reduced risk of death from esophageal cancer (HR, 0.60; 95% CI, 0.46 to 0.80). Death from other causes was similar between study arms (HR, 1.17; 95% CI, 0.68 to 1.99). Although a clear effect on isolated locoregional (HR, 0.40; 95% CI, 0.21 to 0.72) and synchronous locoregional plus distant relapse (HR, 0.43; 95% CI, 0.26 to 0.72) persisted, isolated distant relapse was comparable (HR, 0.76; 95% CI, 0.52 to 1.13). CONCLUSION The overall survival benefit of patients with locally advanced resectable esophageal or junctional cancer who receive preoperative chemoradiotherapy according to CROSS persists for at least 10 years.