食管鳞癌新辅助放化疗后完全缓解是否仍需手术  

Is esophagectomy necessary for esophageal cancer patients with complete response after neoadjuvant chemoradiotherapy

作　　者：傅剑华[1] 谭子辉 Fu Jianhua;Tan Zihui(Department of Thoracic Surgery,Sun Yat-sen University Cancer Center,State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine,Guangdong Esophageal Cancer Institute,Guangzhou 510060,China)

机构地区：[1]中山大学附属肿瘤医院胸外科,广州510060

出　　处：《中华胃肠外科杂志》2018年第9期983-986,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：食管癌是我国常见的恶性肿瘤之一，越来越多的研究证明局部晚期潜在可切除食管癌推荐综合治疗．尤其应用新辅助放化疗来延长患者的生存。然而不同的患者对放化疗敏感性不一．既往报道表明．病理完全缓解（pCR）是新辅助放化疗食管癌患者独立的预后因素，pCR的患者其预后明显优于非pCR患者。直肠癌的“watch and wait”治疗策略认为，临床完全缓解（cCR）的患者可进行密切随访，或许也可获得较好的生存。食管癌能借鉴此策略吗？本文针对新辅助放化疗后cCR的患者是否应行手术进行了剖析。鉴于就目前的疗效评估手段，cCR并不能较好地预测pCR，加上手术治疗的确切疗效和手术风险的不断下降，我们认为，局部晚期食管癌患者仍应以手术为主的综合治疗。Esophageal cancer is one of the common cancers in China. More and more researches indicated that comprehensive treatment should be recommended for locally advanced esophageal cancer with resectable potential, especially the application of neoadjuvant chemoradiotherapy （CRT） was used to improve survival. However, the response to neoadjuvant chemoradiotherapy is various due to individual heterogeneity. Previous studies showed that pathological complete response （pCR） was considered as an important predictor of improved prognosis in esophageal cancer patients undergoing neoadjuvant CRT. Esophageal cancer patients with pCR had better prognosis than those without pCR. The watch and wait strategy may be a feasible option for surgically eligible rectal cancer patients with clinical complete response （cCR） after neoadjuvant chemoraidotherapy. Can the watch and wait strategy be used for reference to esophageal cancer？ Whether patients with cCR following neoadjuvant CRT should undergo operation is analyzed in this article. According to present efficacy evaluation, cCR is inadequate to predict pCR. In addition, esophagectomy is and controllable complications. favored for its curative effect Therefore, we believe surgical resection, the chief component of multimodality treatment, should be recommended for all patients with locally advanced esophageal cancer.

关 键 词：食管鳞癌 新辅助放化疗 临床完全缓解 病理完全缓解 手术治疗 

分 类 号：R735.1[医药卫生—肿瘤]