A meta-analysis of randomized controlled trials that compared neoadjuvant chemotherapy and surgery to surgery alone for resectable esophageal cancer

BACKGROUND: Esophagectomy is often considered the standard treatment for resectable esophageal cancer but the rate of cure is low. Combining neoadjuvant chemotherapy with surgery has theoretical appeal and some clinical evidence suggests a benefit. We performed a meta-analysis of randomized controlled trials (RCTs) that compared neoadjuvant chemotherapy and surgery with surgery alone for esophageal cancer. METHODS: Medline and manual searches were done to identify all published RCTs that compared neoadjuvant chemotherapy and surgery to surgery alone for esophageal cancer. The selection process was inclusive; no trials were excluded. Trial validity assessment was done and a trial quality score was assigned. Outcomes assessed by meta-analysis included 1-, 2-, and 3-year survival, rate of resection, rate of complete resection, operative mortality, anastomotic leaks, postoperative pulmonary complications, all treatment mortality, local-regional cancer recurrence, distant cancer recurrence, and all cancer recurrence. A random-effects model was used and odds ratio was the principal measure of effect. Systematic quantitative review was done for outcomes unique to the neoadjuvant chemotherapy treatment group (clinical response, pathological complete response, and chemotherapy mortality). RESULTS: Eleven RCTs, which included 1,976 patients, were selected with quality scores ranging from 1 to 3 (5-point Jadad scale). Odds ratio (95% confidence interval [CI]; P value), expressed as chemotherapy and surgery versus surgery alone (treatment versus control; values <1 favor chemotherapy-surgery arm), was 1.00 (0.76, 1.30; P = 0.98) for 1-year survival, 0.88 (0.62, 1.24; P = 0.45) for 2-year survival, 0.77 (0.37, 1.59; P = 0.48) for 3-year survival, 1.71 (1.22, 2.40; P = 0.002) for rate of resection, 0.71 (0.58, 0.87; P = 0.001) for rate of complete resection, 0.94 (0.66, 1.35; P = 0.76) for operative mortality, 1.08 (0.45, 2.60; P = 0.87) for anastomotic leaks, 1.31 (0.77, 2.23; P = 0.32) for postoperative pulmonary complications, 1.36 (0.83, 2.25; P = 0.22) for all treatment mortality, 0.71 (0.36, 1.42; P = 0.33) for local-regional cancer recurrence, 0.79 (0.57, 1.10; P = 0.16) for distant cancer recurrence, and 0.63 (0.28, 1.41; P = 0.26) for all cancer recurrence. A clinical response to chemotherapy was observed in 31% of patients and 5% had a complete pathological response. Chemotherapy mortality (before surgery) was 1.6%. CONCLUSIONS: Compared with surgery alone, neoadjuvant chemotherapy and surgery is associated with a lower rate of esophageal resection but a higher rate of complete (R0) resection. It does not increase treatment related mortality. This meta-analysis did not demonstrate a survival benefit for the combination of neoadjuvant chemotherapy and surgery.     

Multimodality treatment for esophageal cancer: the role of surgery and neoadjuvant therapy

Treatment of esophageal cancer has traditionally included surgery as the initial modality. Neoadjuvant chemoradiation therapy has been introduced with the goal of downstaging tumors before surgical resection; however, its role in esophageal cancer remains controversial. We report 116 patients who underwent esophagogastrectomy with reconstruction for carcinoma of the esophagus or esophagogastric junction over a 10-year period (January 1, 1990 to June 1, 2001). Forty patients underwent neoadjuvant radiation and chemotherapy followed by surgery. Hospital mortality in this group was 7.5 per cent, complete pathologic response (CPR) was 37.5 per cent, and overall 3- and 5-year survival rates were 47 and 38 per cent. Five-year survival in the 15 patients with CPR was 85 per cent. Five patients underwent neoadjuvant single-agent therapy (four chemotherapy and one radiation) followed by surgery, and none survived to 3 years. Seventy-one patients underwent surgery without neoadjuvant therapy. Hospital mortality in this group was 1.4 per cent, with 3- and 5-year survival of 21 and 17 per cent--a decreased long-term survival compared with the neoadjuvant therapy group despite the observation that patients who underwent neoadjuvant therapy had a larger tumor size on presentation (5.5 +/- 0.4 cm vs 3.8 +/- 0.2 cm; P = 0.002). Squamous cell carcinomas seemed to be more responsive to neoadjuvant radiation and chemotherapy followed by surgery than were adenocarcinomas, with a CPR of 44.4 versus 35.5 per cent; however, 5-year survival rates in these complete responders were not significantly different (100% and 78%, respectively; P = 0.97). We report that esophagogastrectomy in conjunction with neoadjuvant therapy results in increased survival compared with surgery without neoadjuvant therapy (P < 0.01), although there may be an increased perioperative mortality associated with neoadjuvant therapy. Further studies are needed to evaluate the role of preoperative chemoradiation and to better identify the pretreatment characteristics of patients with a complete pathological response.     

A Highly Active and Tolerable Neoadjuvant Regimen Combining Paclitaxel,Carboplatin, 5-FU,and Radiation Therapy in Patients with Stage II and III Esophageal Cancer

BACKGROUND: The present phase II study aimed to assess the feasibility and efficacy of a new paclitaxel-based neoadjuvant chemoradiation regimen followed by surgery in patients with stage II-III esophageal cancer. METHODS: From January 2002 to November 2004, 50 patients with a potentially resectable stage II-III esophageal cancer received chemotherapy with paclitaxel, carboplatin, and 5-FU in combination with radiotherapy 45 Gy in 25 fractions. Surgery followed 6-8 weeks after completion of neoadjuvant treatment. RESULTS: Patient characteristics: male/female: 44/6, median age 60 years (34-75), median WHO 1 (0-2), adenocarcinoma (n = 42), squamous cell carcinoma (n = 8). Toxicity was mild, and 84 % of the patients completed the whole regimen. Forty-seven patients underwent surgery with a curative intention (transhiatal n = 44, transthoracic n = 3). Pathologic complete tumor regression was achieved in 18 of 47 operated patients (38%). R0 resection was achieved in 45 of 47 operated patients (96%). There were four postoperative deaths (8.5). Postoperative complications were comparable with other studies. After a median follow-up of 41.5 months (21-59) estimated 3- and 5-year survival on an intention-to-treat basis was 56 and 48%. Estimated 3-year survival in responders was 61%, in nonresponders 33%. CONCLUSION: This novel neoadjuvant chemoradiation regimen for treatment of patients with stage II-III esophageal cancer is feasible. Results are encouraging with a high pathologic complete tumor regression and R0 resection rate and an acceptable morbidity and mortality. Preliminary survival data are very promising.     

Neoadjuvant Chemoradiotherapy for Esophageal Cancer: A Review of Meta-Analyses

Background  

Most randomized controlled trials (RCTs) that have compared neoadjuvant chemoradiation followed by surgery with surgery alone for locally advanced esophageal cancer have shown no difference in survival between the two treatments. Meta-analyses on neoadjuvant chemoradiation in esophageal cancer, however, are discordant.     

颈段食管癌施行保留咽和喉手术为主的综合治疗远期疗效

目的探讨以胸外科为主的多学科综合治疗对颈段食管癌的远期疗效。方法回顾性分析北京大学肿瘤医院胸外科单一手术组2000年3月至2011年3月间施行以胸外科保留咽、喉手术为主的多学科综合治疗的41例颈段食管癌患者的临床及随访资料．并与同期同一手术组治疗的480例非颈段食管癌进行比较。结果41例颈段食管癌患者中男28例,女13例,平均年龄62岁。接受术前化疗30例．术后化疗25例,手术前后均予以化疗21例,术后放疗6例。除4例仅行探查手术外,另37例行食管癌根治性切除颈部吻合,其中1例围手术期死亡。接受根治性切除术并顺利出院的36颈段食管癌患者术后1、3、5和8年累计生存率分别为96．8％、52．6％、35．1％和35．1％：而同期接受根治性切除术并顺利出院的457例非颈段食管癌患者的1年、3年、5年和8年累计生存率分别为85．0％、54．3％、45．0％和36．7％;两组差异无统计学意义（19〉0．05）。结论以胸外科为主的多学科综合治疗颈段食管癌能够获得较为满意的远期疗效。     

Multimodality treatment of esophageal cancer

Stage specific management of non-small cell lung cancer is widely accepted. The use of pretreatment disease stage to guide therapy for esophageal cancer is an intellectually appealing concept. To date, there isa relative lack of data upon which one may base stage specific treatment decisions for esophageal carcinoma. This is because thorough pretreatment TNM staging is not universally practiced. As a result, stage-specific treatment varies widely. Based upon the available data, surgery alone may be appropriate for resectable, node-negative disease. In the case of clearly un-resectable disease, definitive chemoradiation is indicated.The value of neoadjuvant or adjuvant treatment modalities in the case of clearly resectable node-negative disease (TlN0 or T2N0) is questionable;however, in the presence of lymph node involvement (N1), or in the case of a marginally resectable primary tumor (T3 or T4), neoadjuvant chemoradiation is probably indicated. Although the achievement ofa complete pathologic response following chemoradiation may obviate surgical resection, even microscopic residual cancer can result in local recurrence. To date, there is no reliable method of ascertaining a complete pathologic response before surgical resection. Therefore, when feasible, the addition of surgical resection following chemoradiation is warranted.Future treatment trials for esophageal cancer should include rigorous pretreatment staging protocols to elucidate stage-specific results of therapy.     

直肠癌腹腔镜与开腹手术肿瘤清除及远期疗效的随机对照试验荟萃分析

目的探讨腹腔镜手术治疗直肠癌的肿瘤清除情况及长期疗效。方法利用电子数据库和手工检索等方法检索Pubmed,Embase。WebofScience及CochraneLibrary截止至2010年6月30日的所有随机对照试验（RCT）文献。评价指标为淋巴结获取数、肿瘤长期疗效（局部复发、切口复发、总体复发、总体生存率及无病生存率）。采用固定效应模型和随机效应模型对直肠癌腹腔镜手术与开腹手术的肿瘤清除情况及长期疗效指标进行荟萃分析。结果符合入选标准的RCT文献有6项共计1033例患者．腹腔镜手术组与开腹手术组分别为577例和456例。两组的淋巴结获取数差异无统计学意义（WMD=-0．38,95％CI：-1．35～0．58,P=0．43）。腹腔镜组环周切缘阳性率（7．94％）高于开腹手术组（5．37％）,但差异无统计学意义[风险比（RR）=1．13,95％CI：0．69-1．85,P=0．63]。局部复发率比较。差异无统计学意义（RR=O．55,95％CI：0．22-1．40,P=0．21）。两组3年总体生存率比较[危险比（HR）=O．76,95％CI：0．54-1．07,P=0．11]。差异无统计学意义;两组3年无病生存率比较（HR=1．16,95％CI：0．61-2．20,P=0．64）,差异亦无统计学意义。结论直肠癌腹腔镜手术在肿瘤清除及长期疗效方面至少与开腹手术相当。     

结直肠癌同时性肝转移新辅助化疗后手术对比直接手术患者的生存疗效

目的对比结直肠癌同时性肝转移行新辅助化疗后手术与直接手术患者的生存疗效。方法本研究采用回顾性队列研究方法,纳入在2008年1月至2018年12月期间,北京大学肿瘤医院肝胆胰外一科收治的282例初始评估为技术上可切除的结直肠同时性肝转移患者。以肝转移术前是否接受过新辅助化疗,分为新辅助化疗组(244例)和直接手术组(38例),比较两组的总生存时间(OS)和无进展生存时间(PFS)。采用倾向性评分校正后进行Cox多因素生存分析,校正的因素包括:性别、年龄、原发肿瘤部位、原发肿瘤T分期、临床风险评分(CRS)、RAS状态、辅助化疗有无、切缘状态。结果244例新辅助化疗组患者术前完成4(1~15)个周期的化疗,其中207例患者一线选择奥沙利铂为主的化疗方案,37例患者一线选择伊利替康为主的化疗方案,90例患者一线联合了靶向治疗。全组患者中位随访时间为30(5~134)个月,失访率1%。未校正前,新辅助化疗组1、3年OS分别为95.1%和66.4%,直接手术组1、3年OS分别为94.7%和51.5%,差异有统计学意义(P=0.026);新辅助化疗组1、3年PFS分别为51.0%和23.4%,直接手术组1、3年PFS分别为39.5%和11.5%,差异有统计学意义(P=0.039)。经倾向性评分校正后,Cox多因素分析显示,新辅助化疗是PFS的独立保护因素(HR=0.664,95%CI:0.449~0.982,P=0.040),但不是OS的独立保护因素(HR=0.651,95%CI:0.393~1.079,P=0.096)。亚组分析显示:新辅助一线化疗有效组(194例,包括完全缓解、部分缓解及缩小但未达到部分缓解)的1、3年OS分别为96.9%和67.1%,优于直接手术组(94.7%和51.5%),经倾向性评分校正后差异有统计学意义(P=0.026);而新辅助一线化疗无效组(50例,包括肿瘤进展或增大)的1、3年OS分别为90.0%和63.3%,与直接手术组(94.7%和51.5%)相比,经倾向性评分校正后差异无统计学意义(P=0.310)。结论对于可切除的结直肠癌同时性肝转移患者,新辅助化疗后行肝切除手术相对于直接手术可使患者获得更长的疾病控制时间,虽然整体OS获益不明显,但新辅助一线化疗有效患者的OS优于直接手术者。     

术前放化疗加胸腹腔镜联合手术在局部中晚期食管癌中的应用体会

目的评估术前放化疗加胸腹腔镜联合手术治疗局部中晚期食管癌的可行性及近期疗效。方法2011年6月至2012年2月间浙江省台州医院共对11例局部中晚期（ⅡB-ⅢA期）食管癌患者予以术前放化疗加胸腹腔镜联合手术。术前化疗采取NP方案（长春瑞滨加顺铂）或TP方案（紫杉醇加顺铂）静脉注射;同期采用常规分割放疗,放疗剂量40Gy／20d。放化疗后4～6周施行胸腹腔镜联合经右胸、上腹、左颈三切口食管癌切除术。结果11例患者均完成预定同步放疗方案,期间9例出现不同程度的骨髓抑制。放化疗结束至手术的时间为（49．6±15．4）d。术中除1例患者（放化疗后75d手术）局部纤维化形成外,其余10例患者手术难度并未增加：与同期15例行单纯腔镜食管切除术的患者相比,手术时间明显缩短[（242．3±27．0）min比（280．5±27．2）min,P=0．002],术中出血量明显减少[（168．2±95．6）ml比（244．5±84．8）ml,P=0．042],淋巴结清扫数量相当[（19．5±5．8）枚／例比（20．5±7．1）枚／例,P=0．683],但术后住院时间延长[（18．9±10．3）d比（12．5±4．6）d,P=-0．020]。术后病理示,4例瘤体明显缩小,7例达到病理完全缓解。术后并发症发生率36．4％（4／11）,其中颈部吻合口瘘并肺部感染1例、颈部吻合口瘘并声嘶1例、肺部感染并胸腔积液2例。术后随访1～9个月,未见肿瘤复发。结论术前放化疗加胸腹腔镜联合手术治疗局部中晚期食管癌安全、可行．近期疗效确切。     

胸腹二野淋巴结清扫结合术后辅助化疗治疗食管癌

目的探讨如何提高食管癌手术根治性、减少术后复发以改善食管癌治疗长期疗效。方法104例胸段食管鳞癌病人，56例按传统术式行食管切除＋肿大淋巴结摘除术，48例行系统性胸腹二野淋巴结清扫术。3例手术死亡（2．9％），余101例病人中29例术后接受顺铂＋氟脲嘧啶辅助化疗，其中15例为传统术式病例，14例为二野清扫病例。结果胸腹二野清扫手术时间虽然较传统术式延长，但手术出血量、术后并发症及病死率未见增高。二野清扫组清扫淋巴结组数（10．5组对3．2组，P〈0．001）及转移淋巴结检出组数（1．1组对0．6组，P=0．038）均显著多于传统术式组。通过淋巴结清扫发现，双侧喉返神经旁（16．8％）、食管旁（22．9％）和胃左动脉旁（16．8％）淋巴结为胸段食管癌常见转移部位，10．4％病例存在跳跃性淋巴结转移，上纵隔（20．8％）与中下纵隔（31．3％）及上腹部（25．0％）3个区域间淋巴结转移频度差异无统计学意义。二野清扫组25．0％病例因扫除了传统术式可能遗漏的转移淋巴结使手术根治性提高，另有12．5％病例手术病理分期因此由pN0上升至pN1。术后辅助化疗病人中86．2％完成2个以上疗程，平均化疗3．1个疗程，无严重毒副作用或死亡。淋巴结清扫组5年生存率显著高于传统术式组（36．4％对24．9％，P=0．049），术后化疗组显著高于未化疗组（44．8％对20．7％，P=0．023），接受淋巴结清扫及术后化疗者5年生存率最高（46．2％），显著高于单纯进行传统手术且未行化疗的病例（19．4％，P=0．018）。结论系统的胸腹二野淋巴结清扫有助于提高食管癌手术根治性和病理分期准确性，淋巴结清扫与术后辅助化疗相结合的优化治疗方法有助于提高胸段食管鳞癌的长期疗效。     

食管癌新辅助放化疗疗效预测分子标志物

局部晚期食管癌单纯手术治疗预后较差,新辅助放化疗并手术治疗的方案可明显延长食管癌患者的总体生存时间.目前,该治疗方案已成为欧美国家及我国对局部晚期食管癌进行规范化治疗的指南.然而,由于只有经新辅助放化疗后获得病理缓解的患者可从中获益,治疗无反应的患者预后可能比单纯手术更差.因此,预测食管癌新辅助放化疗的疗效,区分优势人群和耐受人群,从而实现个体化的治疗极为重要.分子标记物用于预测食管癌新辅助放化疗的疗效研究前景广阔,有望广泛应用于临床实践,指导局部晚期食管癌个体化治疗方案的决策.     

Determinants of prognosis in breast cancer patients with tumor involvement of the skin (pT4b)

Determinants of prognosis were studied in patients with breast cancer with histologically proven tumor extension to the skin without clinical evidence of distant metastases (i.e., pT4b N0-3 M0). Data were collected retrospectively on 77 consecutive patients diagnosed in one community teaching hospital over the period from 1980 to 1995. The prognostic factor of tumor size showed a 5-year survival rate for patients with a tumor 相似文献   

直肠癌新辅助治疗有效性与安全性的Meta分析

目的系统评价新辅助治疗在直肠癌中的治疗作用及其对术后并发症的影响。方法检索2010年5月前在PubMed．Ovid,WebofScience,Springer-Link,ElsevierScienceDirect等数据库已公开发表的比较直肠癌新辅助治疗与单纯手术或术后辅助治疗的随机对照试验（RCT）,并进行入选标准和质量评价．对符合标准的文献提取相关临床效应指标进行Meta分析。结果11篇RCT共7407例患者纳入分析．新辅助治疗组3685例,对照组为3722例。直肠癌新辅助治疗组局部复发率（OR=O．43,95％CI：0．37-0．50,P〈0．01）、远处转移率（OR=0．85,95％CI：0．76-0．95,P〈0．01）、5年生存率（RR=1．15,95％CI：1．04-1．28,P〈0．01）及保肛手术率（RR=I．48,95％CI：1．17-1．87,P〈0．01）均优于对照组,差异有统计学意义,但术后死亡率（DR=1．20,95％CI：0．68-2．13,P=0．53）及吻合口并发症发生率（OR=1．04,95％CI：0．73-1．48,P=0．84）的差异无统计学意义。结论直肠癌新辅助治疗有利于控制局部及远处复发．提高远期生存,未明显增加术后并发症的发生率。     

Tumor response to induction chemoradiation: influence on survival after esophagectomy.

OBJECTIVE: Preoperative chemoradiation is becoming standard of care for locally advanced esophageal cancer. The objective of this study was to determine if the degree of pathologic response to preoperative chemoradiation could predict survival and recurrence after resection in patients with adenocarcinoma of the distal esophagus. METHODS: Between January 1998 and December 2001, 366 patients underwent esophagectomy for adenocarcinoma of the esophagus; 108 (30%) had induction chemoradiation prior to surgery. The records of these 108 patients were reviewed. RESULTS: Histologic examination of the resected specimens documented complete pathologic response (CR) in 24 patients (22%) and residual tumor (RT) in 84 (78%). Operative mortality was 3.7%. Follow-up was complete in all patients and ranged from 1 to 46 months (median, 11 months). Three-year survival for patients with CR was 64% as compared to 34% for patients with RT (P=0.17). Median survival for patients with CR has not yet been reached; however, median survival for patients with RT was 19 months. Three-year cancer free survival for patients with CR was 57% compared to 30% for patients with RT (P=0.03). While median survival free of recurrence for patients with CR has not yet been reached, median survival free of recurrence for patients with RT was 9 months. CONCLUSION: Complete pathologic response to induction chemoradiation is associated with improved early overall and disease-free survival following esophagectomy for adenocarcinoma of the distal esophagus. Because recurrent cancer still develops in many of these patients, even after complete pathologic response, the search for the optimal treatment continues.     

进展期直肠癌新辅助放疗与化放疗联合TME随机对照试验的Meta分析

目的评价新辅助放疗组与新辅助化放疗组联合全直肠系膜切除术(TME)治疗局部进展期直肠癌的安全性与疗效。 方法检索2002年至2017年PubMed、OVID、Cochrane图书馆、中国生物医学文献数据库(CBM)、中国知网全文数据库(CNKI)、万方数据库关于新辅助治疗联合TME手术治疗局部进展期直肠癌的文献,对符合纳入标准的文献进行质量评价,采用Revman5.0软件检验异质性,进行meta分析。 结果共4个随机对照试验共2 272例直肠癌患者纳入研究,新辅助放疗组1 133例患者,新辅助化放疗组1 139例患者。与新辅助化放疗组相比,单纯新辅助放疗组的完全病理缓解率更低(OR＝0.32, 95%CI: 0.22～0.44, P<0.05),5年局部复发率更高(OR＝2.13, 95%CI: 1.62～2.79, P<0.05),严重不良反应更少(OR＝0.38, 95%CI: 0.17～0.82, P＝0.01),差异有统计学意义。但保肛率、术后并发症发病率、5年无病生存率和总生存率差异无统计学意义。 结论新辅助化放疗总体上优于单纯新辅助放疗治疗进展期直肠癌,但临床应用中仍需要根据患者的耐受情况选择合适的新辅助治疗方案。     

Preoperative chemoradiation for rectal cancer: results of multimodality management and analysis of prognostic factors

BACKGROUND: Our goals were to examine the impact of neoadjuvant chemoradiation for rectal cancer on surgical outcomes and to determine prognostic factors predicting improved survival. METHODS: Retrospective cohort of 56 male and 44 female patients. RESULTS: After preoperative chemoradiation, 73% of patients had sphincter-preserving surgery. The 5-year disease-free (DFS) and overall survival rates were 77% and 81%, respectively. Twenty-five percent of patients showed a complete pathologic response. T-level downstaging and pathologic T stage did not correlate with recurrence or survival rates. Pathologic nodal stage was associated with a significant difference in recurrence rates (N(0) 19%, N1 20%, and N2 75%, P = .038) and DFS (N0/N1 vs. N2, 79% vs. 25%, P = .002). CONCLUSION: Neoadjuvant chemoradiation resulted in a high rate of sphincter preservation. Complete pathologic responses after surgery were frequent and although pathologic T stage after surgery did not affect recurrence rates, pathologic nodal response was associated with improved recurrence and survival rates.     

手术联合术前放化疗治疗食管鳞癌

目的 观察术前放化疗对中晚期食管鳞癌(ESCC)患者病理分期和预后的影响.方法 1997年至2007年,477例晚期食管鳞癌随机分为4组:术前化疗组、术前放疗组、术前放化疗组及单纯手术组(对照组),对比各组切除率、病理分期、相关并发症及生存率.结果 术前放疗组及术前放化疗组与对照组对比,根治性切除率提高(P＜0.05),且术后病理分期显著降期(50.8%、54.2%比0%,P＜0.05),而术前化疗组与对照组对比,切除率及病理分期均无显著改善.各组新辅助疗法相关并发症与对照组对比差异无统计学意义(P＞0.05).3年生存率术前放疗组、术前放化疗组及对照组分别为69.5%、72.9%、53.4%,对比差异有统计学意义(P＜0.05).术前放疗组、术前放化疗组与对照组5年生存率对比差异有统计学意义(P＜0.05),放化疗组高于放疗组,但差异无统计学意义(P＞0.05).结论 合理应用术前放化疗可有效提高中晚期食管鳞癌患者的根治性切除率及生存率.     

新辅助放化疗后行腹腔镜手术与开腹手术治疗进展期直肠癌的meta分析

目的:应用meta分析评价新辅助放化疗后行腹腔镜手术与开腹手术治疗进展期直肠癌的可行性及疗效。方法:利用计算机检索Pub Med、Embase、Cochrane Library等数据库,检索新辅助放化疗后行腹腔镜手术对比开腹手术治疗进展期直肠癌的英文文章,采用Rev Man 5.3软件进行meta分析。结果:共纳入2篇随机对照试验、7篇非随机对照试验,共1 338例患者,其中腹腔镜组691例,开腹组647例,meta分析结果显示,新辅助放化疗后,两组患者环周切缘阳性(OR=1.24,95%CI:0.74~2.08,P=0.42)、淋巴结摘除数量(WMD=-0.35,95%CI:-1.48~0.78,P=0.54)差异均无统计学意义;腹腔镜组手术时间长于开腹组(WMD=26.26,95%CI:4.59~47.92,P=0.02),但术中出血量(WMD=-46.48,95%CI:-72.85~-20.11,P=0.0006)、术后住院时间(WMD=-1.80,95%CI:-2.85~-0.74,P=0.0009)、术后并发症(OR=0.77,95%CI:0.60~0.99,P=0.04)均少于开腹组;二次手术(OR=1.30,95%CI:0.61~2.77,P=0.49)两组差异无统计学意义。结论:短期疗效、病理学结果显示,新辅助放化疗后行腹腔镜手术与传统开腹手术治疗进展期直肠癌是安全、有效的。     

外科治疗食管鳞癌的长期生存结果——上海市胸科医院单中心结果分析

目的分析外科治疗食管鳞癌的长期生存结果及影响因素。 方法回顾上海市胸科医院2012—2014年间外科治疗的所有食管鳞癌患者,选取其中经胸手术患者864例作为研究对象,分析患者的一般情况、手术方式、术后恢复及长期生存结果和影响因素。 结果864例患者中,男性占84.7%;cⅡ期和cⅢ期患者分别占44.9%%和30.4%。8.3%的患者采用新辅助治疗。右胸进路手术占88.7%,微创食管癌切除术(MIE)占23.6%。手术总体并发症发生率为41.8%;90 d病死率为3.1%;总体复发率为38.1%;1、3、5年总体生存率分别为85.5%、61.2%和49.3%。MIE患者的远期生存率为66.5%,高于开放手术的44.0%,差异有统计学意义(P<0.001)。与未行术后辅助治疗患者比较,术后辅助治疗在淋巴结阳性患者和阴性的T3N0患者中均显示可以改善总体生存率(33.3% vs 31.5%,P＝0.001;66.0% vs 49.5%,P＝0.004)。 结论外科手术联合术后辅助治疗可以获得比较满意的食管鳞癌远期生存效果,新辅助治疗的作用需进一步研究。     

Preoperative radiation therapy for clinically resectable adenocarcinoma of the rectum.

This is an analysis of 71 patients with clinically resectable adenocarcinoma of the rectum treated with preoperative irradiation and surgery at the University of Florida from July 1975 through December 1981. Seven patients were found to have liver metastasis at surgery; six had a complete resection of their primary rectal lesion and one had an incomplete resection of the rectal tumor. The remaining 64 patients had no evidence of metastasis at the time of surgery and underwent a complete resection of their rectal cancer. In the early years of the trial, the maximum tumor dose consisted of 3000 to 3500 rad in 3.5 to 4 weeks; the dose was subsequently increased to 4500 rad in 5 weeks. Patients were taken to surgery between 2 and 11 weeks (mean, 3.5 weeks) following the completion of radiation therapy. All patients have a minimum follow-up of 3 years and 63% have a minimum follow-up of 5 years. The acute complications of treatment have been acceptable, with only one patient requiring a treatment rest for moist desquamation of the perineum. All patients completed the irradiation course and all were operated on. Pathologic examination of the surgical specimen revealed no tumor in 11%, and the incidence of positive lymph nodes was 19%, which was half the incidence of positive lymph nodes in a series of historical controls treated from 1959 to 1976 with surgery alone. Comparison of patients treated with preoperative irradiation and surgery with those treated with surgery alone revealed that the postoperative complications have been similar in incidence, distribution, and severity. There have been no postoperative deaths. The overall incidence of local-regional recurrence is 5/64 (7.8%), and the combined incidence of local-regional recurrence and/or distant metastasis is 18/64 (28%). The incidence of local-regional recurrence by preoperative dose is 3/23 (13%) for doses of 3000 to 3500 rad and 2/41 (5%) for doses of 4000 to 5000 rad. The 5-year local-regional failure rate is 3/40 (7.5%) for the group irradiated before surgery, and 39/135 (29%) for the historical controls managed by surgery alone (significance level = 0.015). The 5-year determinate disease-free survival is 27/38 (71%) for the patients irradiated before surgery, and 47/114 (41%) for the historical group of patients treated with surgery alone (significance level = 0.008).