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The Journal of Cardiovascular Surgery 2002 August;43(4):531-7


lingua: Inglese

Trimodality treatment versus surgery alone for esophageal cancer. A stratified analysis with minimally invasive pretreatment staging

Jiao X. 1, Sonett J. 1, Gamliel Z. 1, Doyle A. 2, Schuetz J. 1, Greenwald B. 3, Suntharalingam M. 4, Krasna M. J. 1

1 Division of Thoracic Surgery 2 Division of Hematology/Oncology 3 Division of Gastrointestinal Medicine 4 Department of Radiation Oncology University of Maryland Medical System Baltimore, Maryland, USA


Back­ground. Accu­rate pre­treat­ment ­staging of esoph­a­geal ­cancer (EC) is impor­tant in the eval­u­a­tion and com­par­ison of ­results of dif­ferent treat­ment modal­ities. Few ­studies ­using min­i­mally inva­sive ­staging tech­niques for ­this pur­pose ­have ­been ­reported. We pre­vi­ously dem­on­strated the use­ful­ness of the tho­rac­os­copic/lapar­os­copic (Ts/Ls) tech­nique in pre­treat­ment ­staging of EC. ­This ­study was con­ducted to eval­uate the ­impact of tri­mod­ality ­based on pre­treat­ment Ts/Ls ­staging diag­nosis on EC.
­Methods. A ret­ro­spec­tive ­study was per­formed on 2 ­groups of EC ­patients. ­Group A (44 ­patients) under­went pre­treat­ment Ts/Ls ­staging and had tri­mod­ality treat­ment. Pre­op­er­a­tive ­therapy con­sisted of con­cur­rent chem­o­therapy (5-FU + cis­plat­inum) and radio­therapy. ­Group B (33 ­patients) under­went sur­gery ­alone. The ­study ­focused on strat­i­fied com­par­ison of pat­terns of recur­rence and sur­vival in dif­ferent pre­treat­ment sur­gical T, N, and TNM ­stage cat­e­go­ries.
­Results. The 3-­year dis­ease ­free sur­vival of ­Group A was 40.8% ­with a ­median sur­vival of 32.0 ­months, it was 43.6% ­with a ­median sur­vival of 23.6 ­months in ­Group B. The dif­fer­ence was not sig­nif­i­cant (p=0.87). ­There was no dif­fer­ence in recur­rence pat­tern ­between the 2 ­groups. ­Patients ­with squa­mous ­cell car­ci­noma in ­Group A had no ­local recur­rence ­during the ­follow-up ­period ­while ­those in ­Group B had a ­high ­local recur­rence ­rate of 40% (p<0.005). ­When strat­i­fied by T ­factor, ­patients ­with ­locally ­advanced T ­stage (T3-4) in ­Group A had a ­lower dis­tant recur­rence ­rate ­than ­their coun­ter­part ­patients in ­Group B (9.1 vs 38.5%, p=0.03), ­they had a ­better sur­vival but the dif­fer­ence was not sig­nif­i­cant (3-­year dis­ease ­free sur­vival: 41.7 vs 17.9%, p=0.14). ­There ­were no sig­nif­i­cant dif­fer­ences in recur­rence pat­tern and sur­vival in dif­ferent N cat­e­go­ries and TNM ­stages ­between 2 ­groups. Mul­ti­var­iate anal­ysis ­showed ­that ­only pre­treat­ment sur­gical N ­status was an inde­pen­dent prog­nostic ­factor for the ­whole ­group (p=0.02).
Con­clu­sions. Pre­treat­ment Ts/Ls ­staging can pro­vide accu­rate ­staging infor­ma­tion for EC ­patients. Tri­mod­ality treat­ment was suc­cessful in ­local con­trol for ­patients ­with squa­mous ­cell car­ci­noma. It was effec­tive in ­reducing dis­tant recur­rence and ­might pro­long sur­vival in ­patients ­with ­advanced T ­stages. Pre­treat­ment ­lymph ­node ­status was the ­most impor­tant prog­nos­ti­cator regard­less of treat­ment ­modality. Pre­treat­ment path­o­log­ical ­staging ­should be ­included in the ­future clin­ical ­trials on mul­ti­mod­ality treat­ments in EC ­patients.

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