术前时间间隔对新辅助性化学放疗对食管癌症手术短期术后结局的影响：使用荷兰上胃肠道癌症审计（DUCA）数据的基于人群的研究
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
影响因子:6.40000
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,
摘要
为了阐明术前时间间隔对食管癌患者短期术后和病理结局的影响，他们接受了新辅助性化学疗法（NCRT），然后进行食管切除术，然后进行术前术对接受多态癌治疗的患者的影响。使用荷兰国家DUCA数据库包括食管切除术。 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包括5052名患者。与诊断到NCRT间隔≤5周相比，8至12周的间隔与总体并发症的风险更高有关（P = 0.049）。与NCRT到11周的NCRT间隔间隔相比，较长的间隔（11-17和> 17周）与较高的总体并发症风险（P = 0.016; P <0.001）和吻合式泄漏（P = 0.004; P = 0.030; P = 0.030）有关，但是间隔> 17周的风险较低，与较高的风险相关。与间隔≤16周相比，较长的总术前间隔与30天死亡率和并发症的风险无关，但较长的总术前间隔（> 25周）与较高的YPT阶段（p = 0.010）（P = 0.010）和较低的病理完全反应率和较低的病理完全反应率（P = 0.013）相关（P = 0.013）。和疾病的进展以及因果关系需要进一步确认。
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.