Evaluation of Treatment Strategies and Survival of Patients with cT4bM0 Esophageal Cancer: A Nationwide Cohort Study.

IF 1.8 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Digestive Surgery Pub Date : 2024-01-01 Epub Date: 2024-08-17 DOI:10.1159/000540214

Jingpu Wang, Eline M de Groot, Zhouqiao Wu, Rob H A Verhoeven, Nadia Haj Mohammad, Stella Mook, Lucas Goense, Sheraz R Markar, Jelle P Ruurda, Richard van Hillegersberg

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Abstract

Introduction: The optimal therapeutic strategy for patients with cT4bM0 esophageal cancer is controversial and varies internationally. This study aimed to describe treatment and survival of patients with cT4bM0 esophageal cancer in the Netherlands.

Methods: Patients staged with cT4bM0 esophageal cancer who were registered in the Netherlands Cancer Registry (NCR) were included. All patients were categorized by the treatment modality received. The Kaplan-Meier method was used to estimate the overall survival of them.

Results: Between 2015 and 2020, 286 patients with cT4bM0 esophageal cancer were included. Treatment consisted of preoperative chemoradiotherapy/chemotherapy followed by surgery (8%), chemoradiotherapy alone (35%), chemotherapy alone (6%), radiotherapy alone (19%), and best supportive care (32%). The median follow-up was 28.1 months. The 1-, 3-, and 5-year survival rates of each group were 82%, 58%, 49% for preoperative therapy plus surgery; 53%, 27%, 16% for chemoradiotherapy only; 13%, 0%, 0% for chemotherapy only; 13%, 0%, 0% for radiotherapy only; and 5%, 0%, 0% for best supportive care.

Conclusion: In a selected group of patients, preoperative therapy followed by esophagectomy may lead to improved survival, which is comparable to patients with <cT4bM0 tumors. Therefore, reevaluation following chemo(radio)therapy is recommended in these patients to evaluate the possibility of additional surgical resection.

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评估 cT4bM0 食管癌患者的治疗策略和生存率：一项全国性队列研究。

背景：cT4bM0食管癌患者的最佳治疗策略在国际上存在争议和差异。本研究旨在描述荷兰 cT4bM0 食管癌患者的治疗和生存情况：方法：纳入在荷兰癌症登记处（NCR）登记的 cT4bM0 食管癌患者。所有患者均按接受的治疗方式分类。结果：结果：2015-2020年间，共纳入286名cT4bM0食管癌患者。治疗方法包括术前化疗/化疗后手术（8%）、单纯化疗（35%）、单纯化疗（6%）、单纯放疗（19%）和最佳支持治疗（32%）。中位随访时间为 28.1 个月。各组的 1 年、3 年和 5 年生存率分别为：82%、58%、49%：术前治疗加手术的生存率分别为82%、58%、49%；仅化疗放疗的生存率分别为53%、27%、16%；仅化疗的生存率分别为13%、0%、0%；仅放疗的生存率分别为13%、0%、0%；最佳支持治疗的生存率分别为5%、0%、0%：在部分患者中，术前治疗后进行食管切除术可能会提高患者的生存率，其生存率与<cT4bM0肿瘤患者相当。因此，建议对这些患者进行化疗（放疗）后的重新评估，以评估是否有可能进行额外的手术切除。

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

Digestive Surgery 医学-外科

CiteScore

4.90

自引率

3.70%

发文量

审稿时长

3 months

期刊介绍： ''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.