在局部晚期食道癌完整反应后食道切除术与积极监测:回顾性分析
Efrat Gur1, Meroslav Lutsyk2, Tomer Meirson1
1Davidoff Cancer Center, Rabin Medical Center-Beilinson Hospital, Petach Tikva 4941492, Israel.
Cancers
|December 30, 2025
概括
对于食道癌患者在新辅助化疗或放射治疗后达到完全反应的患者,手术对70岁以下的患者提供生存益处. 老年患者可能更受益于监测,避免手术风险.
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:
- 食道癌 (EC) 是一种致命的恶性瘤,标准治疗包括新辅助化学放射治疗 (nCRT),其次是局部晚期疾病的手术.
- 在nCRT后获得临床完整响应 (cCR) 的患者的最佳管理,特别是关于食道切除术的作用,仍然是临床不确定性的领域.
研究的目的:
- 评估食管切除与监测对胸腔食管癌患者的生存结果的影响,这些患者在新辅助化疗或放射治疗 (nCRT) 后获得了临床完整反应 (cCR).
- 确定患者年龄是否影响局部晚期食道癌的nCRT后手术干预的益处.
主要方法:
- 在2013-2023年期间,对252名胸部EC患者 (cT2-4a,N+,M0阶段) 进行了回顾性分析,这些患者接受了nCRT (cisplatin/5-FU或CROSS疗法) 治疗.
- 获得cCR (阴性活检,EUS,PET-CT) 的患者被分为手术 (n=70) 或监测 (n=48) 组.
- 使用卡普兰-梅尔和考克斯回归分析了生存结果 (总生存 - OS,无疾病生存 - DFS),并根据年龄 (≤70 vs. >70岁) 分析了子组分析.
主要成果:
- 在118名达到cCR的患者中,有70人接受了手术和48人接受了监测; 47%的手术患者实现了病理完整反应 (pCR).
- 总体而言,在5年的生存期 (48%的监测与49%的手术) 或DFS (36%与43%的DFS) 中没有明显的差异.
- 在70岁以下的患者中,手术显著改善了OS和DFS (HR=0.44,p=0.03);然而,在70岁以上的患者中,结果趋于反对手术. 高龄和女性性别是OS的独立预测因素.
结论:
- 对于年轻的患者 (≤70岁) 在nCRT后出现cCR,食管切除提供了显著的生存益处,支持其作为首选治疗的作用.
- 在老年患者 (>70岁) 中,监测显示了与手术相当或优于手术的结果,这表明推迟手术可能会降低发病率而不会影响存活率.
- 针对年龄的治疗策略对于优化食道癌患者的治疗决策至关重要,这些患者在nCRT后实现了cCR.
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