Prolonged Time to Surgery in Patients with Residual Disease After Neoadjuvant Chemoradiotherapy for Esophageal Cancer.

IF 7.5 1区医学 Q1 SURGERY Annals of surgery Pub Date : 2024-08-13 DOI:10.1097/SLA.0000000000006488

Hidde C G Overtoom, Ben M Eyck, Berend J van der Wilk, Bo J Noordman, Pieter C van der Sluis, Bas P L Wijnhoven, J Jan B van Lanschot, Sjoerd M Lagarde

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引用次数: 0

Abstract

Objective: To investigate whether prolonged time to surgery negatively affects survival, pathological outcome or postoperative complications in patients with histologically proven residual disease after neoadjuvant chemoradiotherapy for locally advanced esophageal cancer.

Summary background data: Historically, the standard time to surgery (TTS) has been six to eight weeks after completion of nCRT. The effect of prolonged TTS is gaining interest, with contradicting results on survival and surgical morbidity. It can be hypothesized that, in patients with residual disease six weeks after completion of nCRT, prolonged TTS might be associated with worse survival and higher morbidity.

Methods: Patients with locally advanced esophageal cancer who had biopsy-proven residual disease six weeks after nCRT and underwent surgery, were categorized according to interval to surgery (TTS>12w vs. TTS≤12w). Primary outcome of this study was overall survival. Secondary outcomes were disease-free survival, surgical outcomes, pathological outcomes, and postoperative complications. Multivariable Cox regression was used for comparing survival and logistic regression for other outcomes, adjusted for the confounders age, cT, cN, Charlson comorbidity index, weight loss during nCRT, and WHO performance score after completion of nCRT.

Results: Forty patients were included for TTS>12w and 127 for TTS≤12w. TTS>12w was associated with better overall survival (adjusted hazard ratio (aHR) 0.46, 95%CI 0.24-0.90), and disease-free survival (aHR 0.48, 95%CI 0.24-0.94), but also with more postoperative respiratory complications (aOR 3.66, 95%CI 1.52-9.59). Other outcomes were comparable between both groups.

Conclusion: Prolonged TTS in patients with histologically proven residual disease after completion of nCRT for esophageal cancer did not have a negative effect on overall and disease-free survival, but patients did have a higher risk for postoperative respiratory complications.

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食管癌新辅助化放疗后残留病灶患者手术时间延长

目的研究延长手术时间是否会对局部晚期食管癌新辅助化放疗后组织学证实有残留疾病的患者的生存、病理结果或术后并发症产生负面影响：从历史上看，标准的手术时间（TTS）是完成新辅助化疗后的六到八周。延长 TTS 的效果越来越受到关注，但在生存率和手术发病率方面的结果却相互矛盾。可以推测，在完成 nCRT 六周后仍有残留疾病的患者中，延长 TTS 可能与生存率降低和发病率升高有关：方法：根据手术间隔时间（TTS>12w vs. TTS≤12w ）对在 nCRT 六周后活检证实有残留疾病并接受手术的局部晚期食管癌患者进行分类。本研究的主要结果是总生存期。次要结果为无病生存率、手术结果、病理结果和术后并发症。比较生存率时采用多变量 Cox 回归，比较其他结果时采用 logistic 回归，并对年龄、cT、cN、Charlson 合并症指数、nCRT 期间体重减轻和完成 nCRT 后的 WHO 表现评分等混杂因素进行调整：TTS>12w的患者有40例，TTS≤12w的患者有127例。TTS>12w与更好的总生存率（调整后危险比（aHR）0.46，95%CI 0.24-0.90）和无病生存率（aHR 0.48，95%CI 0.24-0.94）相关，但也与更多的术后呼吸系统并发症（aOR 3.66，95%CI 1.52-9.59）相关。两组患者的其他结果相当：结论：组织学证实有残留病灶的食管癌患者在完成 nCRT 治疗后延长 TTS 不会对总生存期和无病生存期产生负面影响，但患者术后出现呼吸系统并发症的风险较高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of surgery 医学-外科

CiteScore

14.40

自引率

4.40%

发文量

687

审稿时长

4 months

期刊介绍： The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.