【研究】食管鳞癌新辅助化疗后肿瘤残留与术后复发情况

中华医学会胸心分会

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前言

虽然新辅助化疗联合手术在日本已成为食管癌的标准治疗方法，但在其他国家应用仍不常见。

尽管新辅助化疗的病理缓解率低于新辅助放化疗，但新辅助化疗联合根治性食管切除加扩大淋巴结清扫已显示出与新辅助放化疗相似的预后，特别是在食管鳞癌中。

由于在新辅助化疗联合手术的策略在一开始并没有提供放射治疗，所以可以考虑在术后复发的情况下通过放化疗进行局部治疗，但该方法是否可以改善患者的预后还不清楚。

为了恰当地实施该方法的前瞻性试验，首先需要仔细评估残余肿瘤细胞的分布，这将有助于确定额外的放化疗是否可以消除新辅助化疗后的残余病灶。另外，新辅助化疗后患者肿瘤残留情况与复发的关系也还没有进一步揭示。

为了解决这些问题，近日在线发表在《外科学年鉴》上的一篇文章分析了食管鳞癌新辅助化疗后病理缓解的患者其肿瘤残留情况及复发模式。

食管鳞癌新辅助化疗后病理缓解的患者其肿瘤残留情况及复发模式

Abstract

— 结论—

新辅助化疗后病理缓解的患者术后复发大多为局部区域的孤立性病灶，很少发生远处转移，这提示我们可以加用放化疗消除残留的肿瘤细胞。

It was found that postoperative recurrence in responders occurred in the regional field mostly as a solitary lesion without the distant failure, indicating that the residual tumor cells can be eliminated by additional chemoradiotherapy.

— 目的—

本研究旨在阐明新辅助化疗后食管鳞癌患者的肿瘤残留情况和复发模式。

This study aimed to elucidate the residual disease distribution and recurrence patterns in patients with ESCC responding to NAC.

— 背景—

为了合理地设计器官保存方法的前瞻性试验，其中包括在对新辅助化疗有反应的患者中增加额外的放化疗，需要阐明残留病的分布。考虑到残存肿瘤位于区域范围内，可以安全地增加放化疗以消除残留病灶。

To appropriately plan a prospective trial for the organ preservation approach which includes additional chemoradiotherapy in patients who responded to NAC, the distribution of residual disease needs to be elucidated. Given that the residual tumor is located in the regional field, chemoradiotherapy can be safely added to eliminate the residual disease.

— 方法—

总共回顾性分析了2个手术量较大的医学中心483例可切除的食管鳞癌患者，他们均接受了新辅助化疗联合经胸食管切除术。

比较不同病理反应程度患者的无复发生存时间、总生存时间(OS)、肿瘤残留情况和肿瘤复发模式。

患者的基本临床病理资料

Overall, 483 patients with resectable ESCC who received NAC followed by transthoracic esophagectomy at 2 high-volume centers were reviewed. The recurrence-free survival, overall survival (OS), and residual and recurrent tumor patterns were compared among the pathological responses.

— 结果—

病理缓解患者与非病理缓解者相比，无复发生存时间（RFS）明显延长[1b/2/3级与0级比较，危险度分别为0.25(P<0.001)/0.17(P<0.001)/0.16(P=0.003)]；

总生存时间（OS）也明显延长[1b/2/3级与0级比较，分别为0.26(P<0.001)/0.12(P<0.001)/0.11(P=0.003)]。

从复发的分布来看，1b级(60%)/2级(67%)/3级(67%)复发率明显更高：1b级(60%)/2级(67%)/3级(67%)，而0级或1a级患者复发率低于25%。

Compared with nonpathological responders, pathological responders exhibited significantly longer recurrence-free survival [hazard ratio of Grade 1b/2/3 compared with Grade 0; 0.25 (P < 0.001) /0.17 (P < 0.001) /0.16 (P = 0.003)] and OS [hazard ratio of Grade 1b/2/3 compared with Grade 0; 0.26 (P < 0.001) /0.12 (P < 0.001) /0.11 (P = 0.003)]. In terms of the distribution of recurrence, the percentages of solitary recurrence in the regional field out of all recurrence was significantly higher in patients with Grade 1b (60%) / 2 (67%) / 3 (67%) whereas less than 25% in Grade 0 or 1a.

来源：知识城邦

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