Impact of Neoadjuvant Chemoradiotherapy on Postoperative Course after Curative-intent Transthoracic Esophagectomy in Esophageal Cancer Patients
Impact of Neoadjuvant Chemoradiotherapy on Postoperative Course after Curative-intent Transthoracic Esophagectomy in Esophageal Cancer Patients
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DOI：
10.1245/s10434-013-3316-8
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发表时间：
2014-02-01
影响因子：
3.7
通讯作者：
Plukker, John Th M.
中科院分区：
文献类型：
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作者：
Bosch, Dirk J.;Muijs, Christina T.;Plukker, John Th M.
背景。新辅助放化疗 (CRT) 可改善食管癌患者的局部控制和总体生存率。尽管新辅助CRT期间不良事件相对较少，但术后可能会发生严重的不良反应，导致发病率甚至死亡。我们研究了更常用的新辅助 CRT 方案，即 41.4 Gy/5 周放疗联合卡铂和紫杉醇（CROSS 方案）对术后病程的影响。方法。 2006年至2012年间，共有96例食管癌患者（cT1N+/T2-4a/N0-3和M0期）按照上述新辅助方案进行治疗。为了减少这项单中心研究中的偏倚，我们对前瞻性维护的数据库 (n = 326) 中仅接受手术的患者 (n = 230) 进行了倾向评分匹配分析。结果。两组之间的基线特征在匹配队列中分布均匀。在新辅助治疗组中，被诊断患有肺炎（27.1% vs. 51.0%；p = 0.001）、胸腔积液（12.5% vs. 24.0%；p = 0.040）和心律失常（20.4% vs. 34.4%；p = 0.008）的患者明显增多。此外，在多变量分析中，新辅助 CRT 与肺炎（p = 0.001，优势比 2.896）、胸腔积液（p = 0.041，优势比 2.268）和心律失常（p = 0.023，优势比 2.215）风险增加显着相关。尽管有这些结果，但在重症监护病房或住院时间方面没有发现差异。两组之间的短期死亡率没有差异。结论。我们观察到新辅助 CRT 组的心肺并发症有所增加，但对住院或重症监护病房的住院时间和死亡率没有任何影响。需要进一步研究放化疗引起的心肺毒性的局限性。
Background. Neoadjuvant chemoradiotherapy (CRT) improves locoregional control and overall survival in esophageal cancer patients. Although adverse events are relatively low during neoadjuvant CRT, severe postoperative adverse effects may occur, leading to morbidity and even mortality. We investigated the impact of a more frequently used neoadjuvant CRT regimen of 41.4 Gy/5 weeks radiotherapy with concurrent carboplatin and paclitaxel (CROSS schedule) on the postoperative course.Methods. Between 2006 and 2012, a total of 96 esophageal cancer patients (staged cT1N+/T2-4a/N0-3 and M0) were treated according to the above neoadjuvant scheme. To reduce bias in this single-center study, we performed a propensity score-matched analysis with patients who underwent surgery alone (n = 230) from a prospectively maintained database (n = 326).Results. Baseline characteristics between both groups were equally distributed in the matched cohort. In the neoadjuvant treated group, significantly more patients were diagnosed with pneumonia (27.1 vs. 51.0 %; p = 0.001), pleural effusion (12.5 vs. 24.0 %; p = 0.040), and arrhythmia (20.4 vs. 34.4 %; p = 0.008). In addition, in the multivariate analysis, neoadjuvant CRT was significantly associated with an increased risk of pneumonia (p = 0.001, odds ratio 2.896), pleural effusion (p = 0.041, odds ratio 2.268), and arrhythmia (p = 0.023, odds ratio 2.215). Despite these outcomes, no differences were detected in duration of intensive care unit or hospital stay. Short-term mortality did not differ between both groups.Conclusions. We observed an increase of cardiopulmonary complications in the neoadjuvant CRT group, without any effect on hospital or intensive care unit stay and mortality. Further research is warranted on the limitation of chemoradiation-induced cardiopulmonary toxicity.