食管癌切除术后临床和生存结果25年来得到改善

Background 背景

In recent decades, there have been major developments in the curative treatment of esophageal cancer, such as the implementation of PET/CT, neoadjuvant chemoradiotherapy, minimally invasive surgery and postoperative care programs.This observational study examined clinical and survival outcomes after esophagectomy for cancer over 25 years.

近几十年来，食管癌的治疗有了重大进展，如PET/CT、新辅助放化疗、微创手术和术后护理方案的实施。这项观察性研究检查了食管癌切除术后25年的临床和生存结果。

Methods 方法

Consecutive patients who underwent esophagectomy for cancer at a tertiary referral center between1993 and 2018 were selected from a prospectively maintained database. Patients were assigned to five periods: 1993–1997, 1998–2002, 2003–2007, 2008–2012, and 2013–2017. The primary outcome was the 5-year overall survival (OS) using Kaplan–Meier log-rank tests for trends.

从前瞻性维护的数据库中选择1993年至2018年期间在三级转诊中心接受食管癌切除术的连续患者队列。患者被分配到5个时期：1993-1997年、1998-2002年、2003-2007年、2008-2012年和2013-2017年。主要结果是5年总生存期(OS)，使用Kaplan-Meier log-rank检验来判断趋势。

Results 结果

 A total of 1616patients were analyzed. The median follow-up of surviving patients was 91.0 months (IQR 62.6–127.5).The 5-year overall survival improved gradually from 32.8to 48.2% over 25 years, P<.001. Hospital length of stay reduced from 16 days (median, IQR 14–24) in 1993–1997 to 11 days (IQR 8–18) in 2013–2017, P<.001. No decrease in mortality was encountered over 25 years, although over the last 5 years, in-hospital and 90-day mortality dropped from 4.2% and 8.3% in 2013 to 0%in 2017, P<.05. Anastomotic leakages reduced from 26.4 to 9.7% between 2013 and 2017, P<.001.

共分析1616例患者。存活患者的中位随访时间为91.0个月(IQR 62.6-127.5)。在25年的时间里，5年总生存率从32.8%逐渐提高到48.2%，P<.001。住院时间从1993-1997年的16天(中位数，IQR 14-24)减少到2013-2017年的11天(IQR 8-18)， P<.001。在过去的5年里，住院和90天死亡率从2013年的4.2%和8.3%下降到2017年的0%，P<.05。吻合口瘘发生率从2013年的26.4%下降到2017年的9.7%，P<.001。

Conclusion 结论

Over the last 25 years, clinical outcomes and 5-year overall survival significantly improved in patients who underwent esophagectomy for cancer at this tertiary referral center.

在过去的25年里，在这个三级转诊中心接受食管癌切除术的患者的临床结果和5年总生存率显著改善。