在患有食道状细胞癌和远端结节转移的患者中进行食道切除术
Chia Liu1, Ping-Chung Tsai2,3, Ling-I Chien4
1Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
概括
患有远程淋巴结转移的食道状细胞癌 (ESCC) 的手术结果比患有区域转移的人更糟. 即使有了病理完整的反应,远程转移也会影响存活率,这表明可能需要辅助治疗.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 胃肠道瘤学 胃肠道瘤学
背景情况:
- 关于手术在寡头转移性食道状细胞癌 (ESCC) 的作用进行了辩论.
- 远程淋巴结 (LN) 转移是ESCC的关键预后因素.
研究的目的:
- 评估ESCC患有远程LN转移 (dLN+) 的ESCC患者食管切除术后的瘤结局,与专门区域性LN转移 (dLN-) 相比.
- 为了比较这些组之间的总生存率 (OS) 和无复发生存率 (RFS).
- 评估病理完整反应 (pCR) 对两组生存的影响.
主要方法:
- 对ESCC患者的回顾性分析,这些患者接受了化学放射治疗或化疗,随后进行了食道切除 (2010-2020).
- 在dLN+ (n=69) 和dLN- (n=111) 患者队列之间的OS和RFS的比较.
- 通过病理完整反应 (pCR) 状态对生存分析的分层分层.
主要成果:
- 与DLN+患者相比,DLN+患者的5年生存率 (25.5%对51.9%) 和RFS (18.1%对47.2%) 与DLN-患者相比显著降低 (P<0.001).
- 在DLN+患者中的43.5%和DLN-患者中的44.1%实现了pCR.
- 在这两组中,pCR显著改善了OS (dLN-: 76.7%对32.4%;dLN+: 39.6%对14.2%).
- DLN-/pCR组的生存率最好;DLN-/非pCR和DLN+/pCR组的生存率相似,两者都优于DLN+/非pCR.
- 不管pCR状态如何,DLN+患者的治疗结果都较差.
结论:
- 与区域性转移相比,ESCC中远程LN转移显著恶化了食道切除术后的生存结果.
- 虽然病理完整反应提高了生存率,但患有远程转移和pCR的患者的结果与没有pCR但仅具有区域转移的患者相似.
- 应考虑对DLN+ESCC患者进行后系统性治疗和手术的辅助疗法,即使在实现pCR之后.
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