ypN3食道癌的困境 ypN3食道癌的问题
Pim B Olthof1, Bo J Noordman2, Sofie P G Henckens3
1Department of Hepatobiliary, Transplant, and Endocrine Surgery, University Hospital Antwerp, Antwerp, Belgium; Department of Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Surgery, Amsterdam UMC, Amsterdam, the Netherlands.
概括
在新辅助疗法后,晚期结节疾病 (ypN3) 显著影响食道切除术的结果. 生存率令人丧,质疑ypN3患者的手术益处,并强调需要改进分期和新辅助治疗.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 胃肠病学 胃肠病学
背景情况:
- 食道切除术是食道癌的关键治疗方法.
- 新辅助疗法通常用于在手术前降低瘤的发展阶段.
- 精确的淋巴结参与的分期对于治疗规划和预后至关重要.
研究的目的:
- 评估新辅助治疗和食道切除术后患有ypN3疾病的患者的结果.
- 评估手术前分期 (cN3) 在识别ypN3疾病时的准确性.
- 为了确定ypN3疾病对生存率和边际状态的影响.
主要方法:
- 对接受食道切除术后新辅助治疗的3901名患者的回顾性分析.
- 对ypN3疾病流行率,生存率和R1边际率的分析.
- 术前cN3分期精度与术后ypN3发现的比较.
主要成果:
- 6%的患者 (244/3901) 患有ypN3疾病.
- ypN3患者的平均整体存活时间为10.0个月,无病存活时间为6.0个月.
- 与其他患者相比,ypN3患者 (21%) 的R1边际率明显高于其他患者 (4%).
- 术前cN3分期对鉴定ypN3疾病的准确性有限 (5%的ypN3患者是cn3;11%的cN3患者患有ypN3疾病).
结论:
- 目前的分期方法不足以准确地在手术前识别患有晚期结节病 (ypN3) 的患者.
- 在食道切除术后患有ypN3疾病的患者的治疗结果不佳,这引发了对该组手术的益处的质疑.
- 需要改善新辅助疗法和成像方法,以更好地选择可能从手术干预中受益的晚期结节疾病患者.
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