Esophagectomy for T1 esophageal cancer: outcomes in 100 patients and implications for endoscopic therapy.
Esophagectomy for T1 esophageal cancer: outcomes in 100 patients and implications for endoscopic therapy.
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DOI：
10.1016/j.athoracsur.2008.12.060
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发表时间：
2009-04
影响因子：
4.6
通讯作者：
Luketich, James D.
中科院分区：
文献类型：
--
作者：
Pennathur, Arjun;Farkas, Andrew;Krasinskas, Alyssa M.;Ferson, Peter F.;Gooding, William E.;Michael, K. Gibson;Schuchert, Matthew J.;Landreneau, Rodney J.;Luketich, James D.
食道切除术是T1食道癌的标准治疗方法。随着人们对内窥镜治疗尤其是T1 EC的兴趣与日俱增，我们的目标是评估食道切除术后的长期结果，并详细检查T1癌的病理特征，以确定潜在的内窥镜治疗的适宜性。我们回顾了连续100例T1、EC患者的食道切除术的结果。研究的主要终点是总生存期(OS)和无病生存期(DFS)。除了详细的病理回顾外，我们还评估了与生存相关的预后变量。T1EC患者100例(男性79例，女性21例，平均年龄68岁)，其中腺癌91例，鳞状细胞癌9例；粘膜内(T1a)29例，粘膜下(T1b)：71例。30d死亡率为0%。99%(99/100)的患者手术切缘为阴性。N1病变21例(T1a：2/29(7%)；T1b：19/71(27%))，伴发重度不典型增生(%)，血管淋巴系侵犯19/100(19/100)。在中位数66个月的随访中，所有患者(包括N1)估计的5年OS和3年DFS分别为62%和80%。结节状态和肿瘤大小分别与总生存率和无瘤生存率显著相关。T1期食道癌患者可以安全地施行食道切除术，远期疗效良好。许多患有T1 EC的患者有几个危险因素，这些因素可能会阻碍内窥镜治疗的适当治疗。需要进一步的前瞻性研究来评估内窥镜治疗。食道切除术应该继续是T1 EC患者的标准治疗方法。
Esophagectomy is the standard treatment for T1 esophageal cancer (EC). With an increasing interest in endoscopic therapies particularly for T1 EC, our objectives were to evaluate the long term outcomes following esophagectomy and to examine the pathological features of T1 cancer in detail to determine the suitability for potential endoscopic therapy. We reviewed the outcomes of esophagectomy in 100 consecutive patients with T1 EC. The primary endpoints studied were overall survival (OS) and disease-free survival (DFS). In addition to detailed pathology review, we evaluated prognostic variables associated with survival. Esophagectomy was performed in 100 patients (79 men, 21 women; median age 68 years) for T1 EC (adenocarcinoma 91, squamous 9; intramucosal (T1a):29, submucosal (T1b):71). The 30 day mortality was 0%. Resection margins were microscopically negative in 99% (99/100) of patients. N1 disease was present in 21 patients (T1a:2/29(7%); T1b:19/71(27%)), associated high-grade dysplasia in 64/100 (64%) and angiolymphatic invasion in 19/100 (19%) of patients. At a median follow-up of 66 months, estimated 5-year OS and 3-year DFS were 62% and 80%, respectively, for all patients (including N1). Nodal status and tumor size were significantly associated with overall survival and disease-free survival, respectively. Esophagectomy can be performed safely in patients with T1 cancer with good long term results. Many patients with T1 EC have several risk factors which may preclude adequate treatment with endoscopic therapy. Further prospective studies are required to evaluate endoscopic therapies. Esophagectomy should continue to remain the standard treatment in patients with T1 EC.
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