围手术期时间间隔对食管癌术后短期结局的影响：基于荷兰上消化道癌症审计（DUCA）数据的人群基础研究

Impact of Preoperative Time Intervals for Neoadjuvant Chemoradiotherapy on Short-term Postoperative Outcomes of Esophageal Cancer Surgery: A Population-based Study Using the Dutch Upper Gastrointestinal Cancer Audit (DUCA) Data

ANNALS OF SURGERY

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: Jingpu Wang, Cas de Jongh, Zhouqiao Wu, Eline M de Groot, Alexandre Challine, Sheraz R Markar, Hylke J F Brenkman, Jelle P Ruurda, Richard van Hillegersberg,

DOI: 10.1097/SLA.0000000000006476

摘要

旨在阐明术前时间间隔对接受新辅助化放疗（nCRT）后行食管切除术患者的短期术后和病理结局的影响。尚不清楚术前不同时间间隔对接受多模态治疗患者的影响。利用荷兰国家DUCA数据库，纳入2010年至2021年接受nCRT及食管切除术的患者（cT1-4aN0-3M0），采用多变量逻辑回归分析不同时间间隔对短期术后及病理结果的影响：诊断至nCRT的时间（≤5、5-8、8-12周）、nCRT至手术的时间（5-11、11-17、>17周）以及总术前时间（≤16、16-25、>25周）。共5052例患者被纳入。与诊断至nCRT间隔≤5周相比，8-12周的间隔与更高的总体并发症风险相关（P=0.049）。与nCRT至手术间隔5-11周相比，11-17周及>17周的较长间隔与更高的总体并发症（P=0.016；P<0.001）及吻合口漏（P=0.004；P=0.030）风险相关，但>17周的间隔与较低的ypN+发生率相关（P=0.021）。较长的总术前时间（>25周）与30天内死亡和并发症的风险无关，但与较高的ypT分期（P=0.010）及较低的病理完全缓解率（P=0.013）相关。在接受nCRT和食管切除术的食管癌患者中，延长手术前时间可能导致更高的发病率和疾病进展，因果关系仍需进一步确认。

Abstract

To clarify the impact of the preoperative time intervals on short-term postoperative and pathologic outcomes in patients with esophageal cancer who underwent neoadjuvant chemoradiotherapy (nCRT) followed by esophagectomy.The impact of preoperative intervals on patients with esophageal cancer who received multimodality treatment remains unknown.Patients (cT1-4aN0-3M0) treated with nCRT plus esophagectomy were included using the Dutch national DUCA database. Multivariate logistic regression was used to determine the effect of different time intervals upon short-term postoperative and pathologic outcomes: diagnosis-to-nCRT intervals (≤5, 5-8, and 8-12 weeks), nCRT-to-surgery intervals (5-11, 11-17, and >17 weeks) and total preoperative intervals (≤16, 16-25, and >25 weeks).Between 2010 and 2021, a total of 5052 patients were included. Compared with diagnosis-to-nCRT interval ≤5 weeks, the interval of 8 to 12 weeks was associated with a higher risk of overall complications ( P =0.049). Compared with nCRT-to-surgery interval of 5 to 11 weeks, the longer intervals (11-17 and >17 weeks) were associated with a higher risk of overall complications ( P =0.016; P <0.001) and anastomotic leakage ( P =0.004; P =0.030), but the interval >17 weeks was associated with lower risk of ypN+ ( P =0.021). The longer total preoperative intervals were not associated with the risk of 30-day mortality and complications compared with the interval ≤16 weeks, but the longer total preoperative interval (>25 weeks) was associated with higher ypT stage ( P =0.010) and lower pathologic complete response rate ( P =0.013).In patients with esophageal cancer undergoing nCRT and esophagectomy, prolonged preoperative time intervals may lead to higher morbidity and disease progression, and the causal relationship requires further confirmation.