食管癌术后复发疾病：荷兰全国象牙研究的一项亚研究

SCI

26 August 2022

RECURRENT DISEASE AFTER ESOPHAGEAL CANCER SURGERY: A SUBSTUDY OF THE DUTCH NATIONWIDE IVORY STUDY

(IF: Ann. Surg., 4.339)

• Kalff MC, Henckens SPG, Voeten DM, Heineman DJ, Hulshof MCCM, van Laarhoven HWM, Eshuis WJ, Baas PC, Bahadoer RR, Belt EJT, Brattinga B, Claassen L, Ćosović A, Crull D, Daams F, van Dalsen AD, Dekker JWT, van Det MJ, Drost M, Duijvendijk PV, Esser SV, Gaspersz MP, Görgec B, Groenendijk RPR, Hartgrink HH, Harst EV, Haveman JW, Heisterkamp J, Hillegersberg RV, Kelder W, Kingma BF, Koemans WJ, Kouwenhoven EA, Lagarde SM, Lecot F, van der Linden PP, Luyer MDP, Nieuwenhuijzen GAP, Olthof PB, van der Peet DL, Pierie JE, Pierik EGJMR, Plat VD, Polat F, Rosman C, Ruurda JP, van Sandick JW, Scheer R, Slootmans CAM, Sosef MN, Sosef OV, de Steur WO, Stockmann HBAC, Stoop FJ, Vugts G, Vijgen GHEJ, Weeda VB, Wiezer MJ, van Oijen MGH, van Berge Henegouwen MI, Gisbertz SS. Recurrent Disease after Esophageal Cancer Surgery: A Substudy of The Dutch Nationwide Ivory Study. Ann Surg. 2022 Jul 26.

• Correspondence: Dr. Suzanne S. Gisbertz, Department of Surgery, Amsterdam UMC, location AMC，PO Box 22660, 1100 DD Amsterdam ,The Netherlands, Tel: +31205669111, Fax: +31 205669243, E-Mail: s.s.gisbertz@amsterdamumc.nl

Objective 目的

This study investigated the patterns, predictors and survival of recurrent disease following esophageal cancer surgery. 

本研究调查了食管癌手术后复发疾病的模式、预测因素和生存率。

Summary Background Data 汇总背景数据

Survival of recurrent esophageal cancer is usually poor, with limited prospects of remission.

复发性食管癌的生存率通常很低，获得急病缓解的前景有限。

Methods 方法

This nationwide cohort study included patients with distal esophageal and gastroesophageal junction adenocarcinoma and squamous cell carcinoma after curatively intended esophagectomy in 2007–2016 (follow-up until January 2020). Patients with distant metastases detected during surgery were excluded. Univariable and multivariable logistic regression were used to identify predictors of recurrent disease. Multivariable Cox regression was used to determine the association of recurrence site and treatment intent with postrecurrence survival.

这项全国性队列研究纳入了2007年至2016年（随访至2020年1月）接受根治性食管切除术后的远端食管和胃食管交界处腺癌和鳞状细胞癌患者。排除了手术中发现的远处转移的患者。单变量和多变量逻辑回归用于确定复发疾病的预测因子。多变量Cox回归用于确定复发部位和治疗意图与复发后生存的相关性。

Results 结果

Among 4626 patients, 45.1% developed recurrent disease a median of 11 months post-operative, of whom most had solely distant metastases (59.8%). Disease recurrences were most frequently hepatic (26.2%) or pulmonary (25.1%). Factors significantly associated with disease recurrence included young age (≤65 years), male sex, adenocarcinoma, open surgery, transthoracic esophagectomy, non-radical resection, higher T-stage and tumor positive lymph nodes. Overall, median post-recurrence survival was 4 months (95%CI 3.6–4.4). After curatively intended recurrence treatment, median survival was 20 months (95%CI 16.4–23.7). Survival was more favorable after locoregional compared to distant recurrence (HR=0.74, 95%CI 0.65–0.84).

在4626名患者中，45.1%的患者在术后11个月内出现复发性疾病，其中大多数患者仅有远处转移（59.8%）。疾病复发最常见的是肝（26.2%）或肺（25.1%）。与疾病复发显著相关的因素包括年龄较轻(≤65岁）、男性、腺癌、开放手术、经胸食管切除术、非根治性切除术、较高T分期和肿瘤阳性淋巴结。总体而言，复发后中位生存期为4个月（95% CI, 3.6–4.4）。经过根治性复发治疗后，中位生存期为20个月（95% CI, 16.4–23.7）。与远处复发相比，局部复发后的生存率更高（HR=0.74，95% CI 0.65–0.84）。

Conclusions 结论

This study provides important prognostic information assisting in the surveillance and counseling of patients after curatively intended esophageal cancer surgery. Nearly half the patients developed recurrent disease, with limited prospects of survival. The risk of recurrence was higher in patients with a higher tumor stage, non-radical resection and positive lymph node harvest.

本研究提供了重要的预后信息，有助于在治疗性食管癌手术后对患者进行监测和咨询。近一半的患者出现复发性疾病，生存前景有限。肿瘤分期较高、非根治性切除和淋巴结切除阳性的患者复发风险较高。

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