食管鳞癌病理分期分层和新辅助化疗疗效对预后影响的全国性验证研究

SCI 15 November 2022

Nationwide validation study of the prognostic significance of stratification using pathological stage and response to neoadjuvant chemotherapy for esophageal squamous cell carcinoma

（Annals of surgery；IF:13.787）

Satoru Matsuda et al. Nationwide validation study of the prognostic significance of stratification using pathological stage and response to neoadjuvant chemotherapy for esophageal squamous cell carcinoma. Annals of surgery. 2022

CORRESPONDENCE TO : kitagawa@a3.keio.jp

Objective 目的

This study aimed to validate the prognostic significance of stratification using pathological stage and response to neoadjuvant chemotherapy (NAC) with a nationwide database from an authorized institute by the Japan Esophageal Society. 

这项研究的目的是通过日本食道学会授权研究所的全国数据库，验证根据病理分期和新辅助化疗(NAC)的反应进行分层的预后意义。

Summary Background Data 背景数据总结 

We proposed the combined criteria using pStage and pathological response. Conducting a validation study using an expanded cohort in the clinical setting would be valuable since it was developed using retrospective data collection. 

我们提出使用pStage和病理反应的联合标准。在临床环境中使用扩大的队列进行验证性研究将是有价值的，因为它是使用回溯性数据收集开发的。

Methods 方法

Patients with esophageal squamous cell carcinoma (ESCC) who underwent subtotal esophagectomy at 85 authorized institutes were retrospectively reviewed for esophageal cancer between 2010 and 2015. The prognostic value of the pathological response was evaluated within the same pStage. Moreover, risk stratification was developed to predict cancer-specific survival (CSS). 

对2010-2015年间在85家机构接受食道次全切除术的食管鳞癌患者进行回顾性分析。在相同的分期内评估病理反应的预后价值。此外，还开发了风险分层来预测癌症特异性生存(CSS)。

Results 结果

The pathological response showed significant stratification of CSS in 3761 patients included in this analysis. We classified the patients into seven groups as survival was significantly different between responders and nonresponders under the stratification with pStage, excluding pStage I comprising pStage 0–I/II responder/II non-responder/III responder/III non-responder/IV responder/IV non-responder with the 5-year CSS of 83.7%/75.8%/68.9%/59.8%/44.4%/40.7%/23.1%, respectively. Furthermore, the area under the curve was significantly higher under the new classification than in the pStage alone (p < 0.001).

在这项分析中的3761名患者中，病理反应显示出明显的CSS分层。我们将患者分为7组，在pStage分层的情况下，除外pStage I，有应答和无应答患者的生存有显著差异，包括pStage 0-I/II应答/II无应答/III应答/III无应答/IV应答/IV无应答，5年的CSS值分别为83.7%/75.8%/68.9%/59.8%/44.4%/40.7%/23.1%。此外，曲线下面积在新的分类下显著高于单独的pStage(p<0.001)。

Conclusions 结论

The prognostic value of classification using pStage and the pathological response was successfully validated using real-world data in Japan. This result would guide appropriate treatment for patients with ESCC who received NAC followed by esophagectomy.

使用日本的真实世界数据成功地验证了使用pStage分类和病理反应的预后价值。这一结果将指导接受新辅助化疗后食道切除术的食管鳞癌患者的合适治疗。

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