超越病理完全缓解：食管及食管胃结合部腺癌多模式治疗后的长期结局——系统综述与个体患者数据荟萃分析
Beyond Pathological Complete Response: Long-term Outcomes in Esophageal and Esophagogastric Junction Adenocarcinoma After Multimodal Therapy-A Systematic Review and Individual Patient-Data Meta-Analysis.
作者
作者单位
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy.
- Upper Gastrointestinal Surgery Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy. giovanni.garbarino@hunimed.eu.
摘要
中文
与新辅助放化疗（nCRT）相比，食管及食管胃结合部（EGJ）腺癌的新辅助化疗（nCT）与更好的生存率相关，但病理完全缓解（pCR）率较低。本研究旨在比较接受nCT或nCRT后达到pCR的食管或EGJ腺癌患者的长期结局。系统检索PubMed、Embase及网络数据库中截至2025年11月的相关文献，筛选比较nCT与nCRT在食管或EGJ腺癌pCR患者中的研究，并对总生存期（OS）和无病生存期（DFS）进行个体患者数据（IPD）荟萃分析。最终纳入来自6项研究的1454例患者（nCT组374例，nCRT组1080例）。nCT组1年、3年和5年OS均优于nCRT组，分别为95.4%对比87.8%、81.5%对比64.8%、73.8%对比56%（p<0.001）。同样，nCT组1年、3年和5年DFS亦显著优于nCRT组（p<0.001）。单阶段荟萃分析显示，nCT与死亡风险降低（HR=0.49，p<0.001）和复发风险降低（HR=0.24，p<0.001）相关。本研究表明，nCT后达到pCR的患者较nCRT后达到pCR者具有更好的长期结局，凸显了nCT在全身疾病控制方面的优势。该结果提示pCR本身不能被视为预后替代指标，将pCR与术前治疗策略相结合进行综合考量至关重要。
English
Neoadjuvant chemotherapy (nCT) for esophageal and esophagogastric junction (EGJ) adenocarcinoma is associated with better survival but worse pathological complete response (pCR) rate as compared with neoadjuvant chemoradiotherapy (nCRT). The aim of the present study is to compare long-term outcomes in patients with esophageal or EGJ adenocarcinoma and pCR after nCT or nCRT. A systematic review of the literature in PubMed, Embase and web sources was performed up to November 2025. Studies comparing nCT and nCRT in patients with esophageal or EGJ adenocarcinoma and pCR were identified. An individual patient-data (IPD) meta-analysis was performed for overall survival (OS) and disease-free survival (DFS). Overall, 1454 patients from six different studies were included (374 in nCT group and 1080 in nCRT group). 1-, 3-, and 5-year OS was superior in the nCT group as compared with nCRT group, being 95.4% versus 87.8%, 81.5% versus 64.8% and 73.8% versus 56%, respectively (p < 0.001). Analogously, superior DFS was observed for the nCT group at one, three and 5 years (p < 0.001). In the one-stage meta-analysis nCT was associated with decreased risk of death (HR = 0.49, p < 0.001) and recurrence (HR = 0.24, p <0.001). The present study showed better long-term outcomes in patients with pCR after nCT when compared with nCRT, highlighting the better systemic disease control offered by the first. This consideration suggests that pCR cannot be considered as a prognostic surrogate per se but the integration of this concept with the type of preoperative strategy is crucial.
分类与指标
- 研究类型
- 综述Meta
- 病种
- 食管癌
- JCR 分区
- Q1
- 影响因子
- 3.8
- 新锐分区
- 2区