Pathologic nodal status predicts disease-free survival after neoadjuvant chemoradiation for gastroesophageal junction carcinoma
Pathologic nodal status predicts disease-free survival after neoadjuvant chemoradiation for gastroesophageal junction carcinoma
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DOI：
10.1245/aso.2006.02.023
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发表时间：
2006-03-01
影响因子：
3.7
通讯作者：
Tyler, DS
中科院分区：
文献类型：
--
作者：
Gaca, JG;Petersen, RP;Tyler, DS
胃食道结合部癌(GEJ)的发病率正在迅速增加，预后仍然很差。我们检查了接受新辅助放化疗的GEJ肿瘤患者的预后，以确定预测无病(DFS)和总体(OS)生存的因素。对1992年至2001年连续101名接受放化疗和手术治疗的GEJ癌患者进行了回顾分析。所有患者的中位DFS和OS分别为16个月和25个月。组织学完全反应(T0N0)的28名患者与所有其他患者相比，经历了更长的DFS(P=0.02)。与N1患者(9个月；P=.01)相比，无论T分期如何，淋巴结阴性患者的中位DFS(24个月)都有所改善。通过单因素分析，术前分期、年龄、肿瘤部位或Barrett‘s食道不能独立预测OS。多变量分析表明，只有治疗后的结节状态(P=0.03)--而不是原发肿瘤的反应程度--才能预测DFS。GEJ肿瘤患者在新辅助治疗后的结节状态对切除后的DFS有预测作用。结节阳性患者的不良结局支持新辅助治疗后的结节分期，因为手术的侵袭性应该通过认识到治愈的可能性和中位生存期的短而得到缓和。
The incidence of carcinoma of the gastroesophageal junction (GEJ) is rapidly increasing, and the prognosis remains poor. We examined outcomes in patients who received neoadjuvant chemoradiation for GEJ tumors to identify factors that predict disease-free (DFS) and overall (OS) survival.A retrospective analysis was performed of 101 consecutive patients who received chemoradiation and surgery for GEJ carcinoma between 1992 and 2001.The median DFS and OS of all patients were 16 and 25 months, respectively. Twenty-eight patients with a complete histological response (T0N0) experienced greater DFS compared with all others (P = .02). Node-negative patients, regardless of T stage, experienced improved median DFS (24 months) compared with N1 patients (9 months; P = .01). Preoperative stage, age, tumor location, or Barrett's esophagus did not independently predict OS by univariate analysis. Multivariate analysis demonstrated that only posttreatment nodal status (P = .03)-not the degree of primary tumor response-predicted DFS.The nodal status of patients with GEJ tumors after neoadjuvant therapy is predictive of DFS after resection. The poor outcome in node-positive patients supports postneoadjuvant therapy nodal staging, because surgical aggressiveness should be tempered by the realization that cure is unlikely and median survival is short.