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2026年8月13日星期四
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基于新辅助化疗与手术的综合治疗联合选择性辅助化疗治疗 cT2N0 食管鳞状细胞癌:一项多中心回顾性研究

Neoadjuvant chemotherapy and surgery-based treatment with selective adjuvant chemotherapy for cT2N0 esophageal squamous cell carcinoma: a multicenter retrospective study.

期刊
Esophagus
PMID
42518071
原文
PubMed ↗
发布日期

作者

  • Tomohira Takeoka — Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, Japan.
  • Hiroshi Miyata — Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, Japan. hiroshi.miyata@oici.jp.
  • Koji Tanaka — Department of Gastroenterological Surgery, Graduate School of Medicine, The University of Osaka, Osaka, Japan.
  • Shigeto Nakai — Department of Gastroenterological Surgery, Graduate School of Medicine, The University of Osaka, Osaka, Japan.
  • Takahito Sugase — Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, Japan.
  • Masaaki Yamamoto — Department of Surgery, NHO Osaka National Hospital, Osaka, Japan.
  • Takashi Kanemura — Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, Japan.
  • Keijiro Sugimura — Department of Surgery, Kansai Rosai Hospital, Hyogo, Japan.
  • Tomoki Makino — Department of Gastroenterological Surgery, Graduate School of Medicine, The University of Osaka, Osaka, Japan.
  • Atsushi Takeno — Department of Surgery, NHO Osaka National Hospital, Osaka, Japan.
  • Osamu Shiraishi — Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan.
  • Masaaki Motoori — Department of Gastroenterological Surgery, Osaka General Medical Center, Osaka, Japan.
  • Makoto Yamasaki — Department of Upper Gastrointestinal Surgery, Kansai Medical University, Osaka, Japan.
  • Motohiro Hirao — Department of Surgery, NHO Osaka National Hospital, Osaka, Japan.
  • Kazumasa Fujitani — Department of Gastroenterological Surgery, Osaka General Medical Center, Osaka, Japan.
  • Takushi Yasuda — Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan.
  • Masahiko Yano — Kyowakai Hospital, Osaka, Japan.
  • Yuichiro Doki — Department of Gastroenterological Surgery, Graduate School of Medicine, The University of Osaka, Osaka, Japan.

作者单位

  • Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, Japan.
  • Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, Japan. hiroshi.miyata@oici.jp.
  • Department of Gastroenterological Surgery, Graduate School of Medicine, The University of Osaka, Osaka, Japan.
  • Department of Surgery, NHO Osaka National Hospital, Osaka, Japan.
  • Department of Surgery, Kansai Rosai Hospital, Hyogo, Japan.
  • Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan.
  • Department of Gastroenterological Surgery, Osaka General Medical Center, Osaka, Japan.
  • Department of Upper Gastrointestinal Surgery, Kansai Medical University, Osaka, Japan.
  • Kyowakai Hospital, Osaka, Japan.

摘要

中文

新辅助化疗(NAC)在临床 T2N0(cT2N0)食管鳞状细胞癌(ESCC)中的作用仍存争议,主要原因是证据有限且临床分期的准确性广受质疑。我们分析了 2000 至 2019 年间接受食管次全切除术的 263 例 cT2N0 胸段 ESCC 患者。患者分为 NAC 联合手术组(n=87)与直接手术组(n=176);后者中 43 例根据病理危险因素接受了辅助化疗。临床分期准确性较低,临床诊断为 T2N0 的患者中仅 15.3% 经术后病理确诊为 pT2N0。23.3% 的患者降期为 pT1N0,而直接手术组中 48.3% 存在隐匿性病理淋巴结转移(pN+)。NAC 组淋巴管侵犯率(37.2% vs. 64.2%,p<0.001)及血管侵犯率(20.9% vs. 46.5%,p<0.001)均较低,但残余淋巴结病变仍较常见(32.2%)。中位随访时间为 59 个月。NAC 组与直接手术组的 5 年总生存期(OS)与无病生存期相当(分别为 70.5% vs. 70.6%,p=0.574;67.8% vs. 65.8%,p=0.817)。两组复发模式相似。在直接手术组 pN+ 患者中,辅助化疗改善了 5 年 OS(72.1% vs. 58.7%,p=0.033),其预后接近 pN0 患者。与直接手术相比,常规 NAC 并未改善 cT2N0 ESCC 的长期生存。对病理证实淋巴结受累的患者采用直接手术联合选择性术后辅助化疗,其生存结局接近 pN0 患者。

English

The role of neoadjuvant chemotherapy (NAC) in clinical T2N0 (cT2N0) esophageal squamous cell carcinoma (ESCC) is controversial, largely due to limited evidence and the well-recognized inaccuracy in clinical staging. We analyzed 263 patients with cT2N0 thoracic ESCC who underwent subtotal esophagectomy between 2000 and 2019. Patients were grouped into NAC plus surgery (n = 87) and upfront surgery (n = 176); 43 patients in the latter group received adjuvant chemotherapy based on pathological risk factors. Clinical staging accuracy was low, with only 15.3% of patients clinically diagnosed with T2N0 confirmed as pT2N0. Downstaging to pT1N0 occurred in 23.3% of patients, while 48.3% in the upfront surgery group showed occult pathological nodal metastasis (pN +). Lymphatic (37.2% vs. 64.2%, p < 0.001) and vascular invasion rates were low in the NAC group (20.9% vs. 46.5%, p < 0.001), but residual nodal disease remained common (32.2%). Median follow-up was 59 months. Five-year overall survival (OS) and disease-free survival were comparable between NAC and upfront surgery groups (70.5% vs. 70.6%, p = 0.574; 67.8% vs. 65.8%, p = 0.817, respectively). Recurrence patterns were similar between groups. Among pN + patients in the upfront surgery cohort, adjuvant chemotherapy improved 5-year OS (72.1% vs. 58.7%, p = 0.033), with outcomes similar to pN0 patients. Routine NAC did not improve long-term survival compared with upfront surgery in cT2N0 ESCC. Upfront surgery followed by selective postoperative adjuvant chemotherapy in patients with pathological nodal involvement was associated with survival outcomes approaching those of pN0 patients.

分类与指标

研究类型
临床研究
病种
食管癌
JCR 分区
Q1
影响因子
5.8
新锐分区
4区