新辅助化放疗的术前时间间隔对食管癌手术术后短期疗效的影响:利用荷兰上消化道癌症审计 (DUCA) 数据进行的人群研究。

IF 7.5 1区 医学 Q1 SURGERY Annals of surgery Pub Date : 2024-11-01 Epub Date: 2024-08-08 DOI:10.1097/SLA.0000000000006476
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
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引用次数: 0

摘要

目的旨在明确术前时间间隔对接受新辅助化放疗(nCRT)后食管切除术的食管癌患者术后短期疗效和病理结果的影响:术前间隔期对接受多模式治疗的食管癌患者的影响尚不清楚:方法:利用荷兰国家 DUCA 数据库纳入了接受 nCRT+ 食管切除术治疗的患者(cT1-4aN0-3M0)。采用多变量逻辑回归确定不同时间间隔对短期术后和病理结果的影响:诊断到nCRT的时间间隔(≤5、5-8和8-12周)、nCRT到手术的时间间隔(5-11、11-17和>17周)以及术前总时间间隔(≤16、16-25和>25周):结果:2010-2021年间,共纳入5052例患者。与诊断到 nCRT 间隔≤5 周相比,8-12 周的间隔与较高的总体并发症风险相关(P=0.049)。与 nCRT 到手术间隔 5-11 周相比,间隔时间越长(11-17 周和 >17 周),总体并发症的风险越高(P-value=0.016;P-value17 周与 ypN+ 的低风险相关(P-value=0.021)。与间隔时间≤16周相比,较长的术前总间隔时间与30天死亡率和并发症风险无关,但较长的术前总间隔时间(>25周)与较高的ypT分期(P-value=0.010)和较低的pCR率(P-value=0.013)有关:结论:对于接受nCRT和食管切除术的食管癌患者,延长术前时间间隔可能会导致更高的发病率和疾病进展,其因果关系有待进一步证实。
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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.

Objective: 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.

Background: The impact of preoperative intervals on patients with esophageal cancer who received multimodality treatment remains unknown.

Methods: 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).

Results: 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).

Conclusions: 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.

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来源期刊
Annals of surgery
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.
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