Posttherapy pathologic stage predicts survival in patients with esophageal carcinoma receiving preoperative chemoradiation
Posttherapy pathologic stage predicts survival in patients with esophageal carcinoma receiving preoperative chemoradiation
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作者：
Chirieac, LR;Swisher, SG;Wu, TT
背景。对于接受术前放化疗的食管或食管胃结合部局部区域癌患者，尚不清楚治疗前临床分期还是治疗后病理分期是否能更好地预测生存率。作者连续研究了 235 名治疗前临床 II、III 或 IVA 期（根据美国癌症联合委员会标准）的食管癌或食管胃交界癌患者，这些患者接受了放化疗，随后进行了食管切除术。使用病理分期和残留癌的半定量评估对治疗后癌症状态进行分类。将临床病理特征、残留癌状态、治疗前和治疗后分期与无病生存率和总生存率进行比较。结果。治疗后病理分期为 29% 的患者为 0 期，11% 的患者为 I 期，34% 的患者为 II 期，20% 的患者为 III 期，6% 的患者为 IV 期。 56% 的患者发生癌症降期。在单变量分析中，无病生存率和总生存率通过治疗后病理分期（均 P < 0.001）、切缘状态（分别为 P = 0.002 和 P = 0.01）、残留癌范围（均 P < 0.001）和降期（均 P = 0.001）来预测，而不是通过年龄、性别、癌症类型、治疗前临床分期或术前方案来预测。然而，在多变量分析中，无病生存率和总生存率是通过治疗后病理分期独立预测的（均为 P = 0.02）。残留癌的范围是总体生存率的一个略微显着的预测因子（P = 0.04）。结论。对于接受放化疗和食管切除术的食管或食管胃交界部局部区域癌患者来说，治疗后病理分期是预后的最佳预测指标。当前研究的结果支持通过术前治疗降期的概念。 (c) 2005 年美国癌症协会。
BACKGROUND. in patients with locoregional carcinoma of the esophagus or esophagogastric junction who underwent preoperative chemoradiation, it is unclear whether survival was better predicted by pretherapy clinical stage or by posttherapy pathologic stage.METHODS. The authors studied 235 consecutive patients with pretherapy clinical Stage II, III, or IVA (according to American joint Committee on Cancer criteria) carcinoma of the esophagus or esophagogastric junction who were treated with chemoradiation followed by esophagectomy. Posttherapy cancer status was classified using pathologic stage and semiquantitative assessment of residual carcinoma. Clinicopathologic features, residual carcinoma status, and pretherapy and posttherapy stage were compared with disease-free and overall survival.RESULTS. Posttherapy pathologic stage was Stage 0 in 29% of patients, Stage I in 11% of patients, Stage II in 34% of patients, Stage III in 20% of patients, and Stage IV in 6% of patients. Cancer downstaging occurred in 56% of patients. In univariate analysis, disease-free and overall survival were predicted by posttherapy pathologic stage (both with P < 0.001), margin status (P = 0.002 and P = 0.01, respectively), extent of residual carcinoma (both with P < 0.001), and downstaging (both with P = 0.001), but not by age, gender, type of cancer, pretherapy clinical stage, or preoperative regimen. However, in multivariate analysis, disease-free and overall survival were independently predicted by posttherapy pathologic stage (both with P = 0.02). Extent of residual carcinoma was a marginally significant predictor of overall survival (P = 0.04).CONCLUSIONS. Posttherapy pathologic stage was the best available predictor of outcome for patients with locoregional carcinoma of the esophagus or esophagogastric junction who underwent chemoradiation therapy followed by esophagectomy. The findings in the current study supported the concept of downstaging by preoperative therapy. (c) 2005 American Cancer Society.