Surgery in oesophago-gastric cancer with metastatic disease: Treatment, prognosis and preoperative patient selection
Surgery in oesophago-gastric cancer with metastatic disease: Treatment, prognosis and preoperative patient selection
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DOI：
10.1016/j.ejso.2015.05.005
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发表时间：
2015-10-01
期刊：
影响因子：
3.8
通讯作者：
Ott, K.
中科院分区：
文献类型：
--
作者：
Schmidt, T.;Alldinger, I.;Ott, K.
背景：手术切除在转移性食管胃腺癌（EGA）中的作用尚未明确，跨学科肿瘤委员会也经常讨论。这项回顾性研究的主要目标是患者术后的结果。我们还根据肿瘤分级、化疗的临床反应和推测的 R 状态评估了我们的术前预后评分 (PPS)。方法：811 名 EGA 患者中有 123 名被评估为 cM1，要么在术中确认，要么通过影像学证实。通过内窥镜检查、CT扫描和组织病理学进行化疗后的反应评估。对前瞻性记录的患者和结果数据进行回顾性分析。结果：纳入 70 例食管胃交界腺癌患者和 53 例胃癌患者。大多数人有一个 M1 位点 (n = 102)。 72 例接受了术前化疗 (CTx)，51 例接受了初次切除。 11 例未经切除进行探查。 49/112 (40%) 进行了多脏器切除，63/112 (56%) 进行了完全切除 (RO)。 26/72 (36%) 是临床反应者，30 名患者具有良好的 PPS。中位生存期为 20.0 个月。切除（尤其是完全切除）和术前 CTx 显着延长了生存期（所有 p = 0.001）。多脏器切除、转移的类型或数量、或原发肿瘤定位对生存没有影响。在接受术前 CTx 的患者中，临床反应和 PPS 显着影响生存。在 RO 切除的患者中，术前 CTx、临床反应和 PPS 仍然具有预后意义。结论：未经术前 CTx 的一期切除不适合转移性 EGA。 PPS 良好且对 CTx 有反应的患者亚组可能是转移性食管胃癌手术切除的良好候选者。 (C) 2015 年，爱思唯尔有限公司出版。
Background: The role of surgical resection in metastatic oesophago-gastric adenocarcinomas (EGA) is not defined and regularly discussed in interdisciplinary tumour boards. Primary objective of this retrospective study was the outcome of patients after surgery. We additionally evaluated our preoperative prognostic score (PPS) based on tumour grading, clinical response to chemotherapy and presumed R-status.Methods: 123 of 811 EGA patients were evaluated as cM1, either confirmed intraoperatively or by imaging. Response evaluation after chemotherapy was performed by endoscopy, CT-scan and histopathologically. The prospectively documented patient and outcome data were analysed retrospectively.Results: 70 patients with adenocarcinoma of the oesophago-gastric junction and 53 patients with gastric cancer were included. The majority had one M1 site (n = 102). 72 received preoperative chemotherapy (CTx) and 51 underwent primary resection. 11 were explored without resection. 49/112 (40%) had multivisceral resections and 63/112 (56%) were completely resected (RO). 26/72 (36%) were clinical responders and 30 patients had a favourable PPS.Median survival was 20.0 months. Survival was significantly prolonged by resection, especially complete resection, and by preoperative CTx (all p = 0.001). Multivisceral resection, type or number of metastases, or primary tumour localization had no impact on survival. In patients undergoing preoperative CTx, clinical response and the PPS influenced survival significantly. In RO resected patients, preoperative CTx, clinical response and the PPS remained prognostic.Conclusion: Primary resection without preoperative CTx is not appropriate for metastatic EGA. Subgroups of patients with a favourable PPS with response to CTx may be good candidates for surgical resection in metastatic oesophago-gastric cancer. (C) 2015 Published by Elsevier Ltd.