食管及胃肠连接部cT2期腺癌的最佳治疗策略：多国高容量中心回顾性队列分析
Optimal Treatment Strategies for cT2 Staged Adenocarcinoma of the Esophagus and the Gastroesophageal Junction: A Multinational, High-volume Center Retrospective Cohort Analysis
DOI 原文链接
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影响因子:6.4
分区:医学1区 Top / 外科1区
发表日期:2024 Nov 01
作者:
Naita M Wirsik, Cezanne D Kooij, Niall Dempster, Nerma Crnovrsanin, Noel E Donlon, Eren Uzun, Kunal Bhanot, Henrik Nienhüser, Daniela Polette, Kammy Kewani, Peter Grimminger, Daniel Reim, Florian Seyfried, Hans F Fuchs, Suzanne S Gisbertz, Christoph-Thomas Germer, Jelle P Ruurda, Fredrik Klevebro, Wolfgang Schröder, Magnus Nilsson, John V Reynolds, Mark I Van Berge Henegouwen, Sheraz Markar, Richard Van Hillegersberg, Thomas Schmidt, Christiane J Bruns
DOI:
10.1097/SLA.0000000000006478
摘要
为评估在食管（EAC）和胃肠连接部（GEJ）腺癌的cT2分期患者中，原发手术（PS）或新辅助治疗后手术（NAT/S）的疗效，开展了一项多国高容量中心研究。由于缺乏随机对照试验，临床分期为cT2cN任意或cT2N0的EAC和GEJ采用NAT/S或PS的最佳治疗方案仍不明确。对来自10个中心的前瞻性维护数据库进行回顾性分析。2012年1月至2023年8月期间，符合包含标准的645例患者接受了旨在根治性治疗的PS或NAT/S。主要终点为总生存期（OS）。在cT2cN任意患者中，192例（29.8%）接受PS，453例（70.2%）接受NAT/S。在所有cT2cN0患者（n=333）中，NAT/S仍为更常用的治疗方式（56.2%）。接受PS的患者在两个cT2队列中均年龄较大（P < 0.001）且具有较高的美国麻醉医师协会（ASA）分类（P < 0.05）。R0切除率在NAT/S与PS之间在两个cT2队列中无差异（P > 0.4）。中位OS在PS组为51.0个月（95% CI：31.6-70.4），而在NAT/S组为114.0个月（95% CI：53.9-174.1）（P=0.003）。对于cT2cN0患者，NAT/S与较长的OS（P=0.002）和无病生存期（P=0.001）相关。在对cT2N0患者进行倾向评分匹配后，NAT/S的生存优势仍然存在（P=0.004）。组织病理学显示，38.1%的cT2cN任意和34.2%的cT2cN0患者分期不足。由于cT2N0疾病的识别不可靠，所有患者都应接受多模态治疗方案。
Abstract
To evaluate outcomes after primary surgery (PS) or neoadjuvant treatment followed by surgery (NAT/S) in cT2 staged adenocarcinomas of the esophagus (EAC) and gastroesophageal junction (GEJ), a multinational high-volume center study was undertaken.The optimal treatment approach with either NAT/S or PS for clinically staged cT2cN any or cT2N0 EAC and GEJ remains unknown due to the lack of randomized controlled trials.A retrospective analysis of prospectively maintained databases from 10 centers was performed. Between January 2012 and August 2023, 645 patients who fulfilled inclusion criteria of GEJ Siewert type I, II, or EAC with cT2 status at diagnosis underwent PS or NAT/S with curative intent. The primary endpoint was overall survival (OS).In the cT2cN any cohort, 192 patients (29.8%) underwent PS and 453 (70.2%) underwent NAT/S. In all cT2cN0 patients (n = 333), NAT/s remained the more frequent treatment (56.2%). Patients undergoing PS were in both cT2 cohorts older ( P < 0.001) and had a higher American Society of Anesthesiologists classification ( P < 0.05). R0 resection showed no differences between NAT/S and PS in both cT2 cohorts ( P > 0.4).Median OS was 51.0 months in the PS group (95% CI: 31.6-70.4) versus 114.0 months (95% CI: 53.9-174.1) in the NAT/S group ( P = 0.003) of cT2cN any patients. For cT2cN0 patients, NAT/S was associated with longer OS ( P = 0.002) and disease-free survival ( P = 0.001). After propensity score matching of the cT2N0 patients, survival benefit for NAT/S remained ( P = 0.004). Histopathology showed that 38.1% of cT2cN any and 34.2% of cT2cN0 patients were understaged.Due to the unreliable identification of cT2N0 disease, all patients should be offered a multimodal therapeutic approach.