可切除的食管胃结合部腺癌的联合治疗

Combined Therapeutic Strategies for Resectable Esophagogastric Junction Adenocarcinoma

近年来胃癌的发病率有所下降,相比之下胃食管结合部腺癌的发病率却快速增长。手术治疗仍然是早期食管胃结合部腺癌的标准治疗方法,同时手术联合化疗、放化疗治疗食管胃结合部腺癌也逐渐得到国际认可。尽管在手术治疗、放疗和化疗治疗技术得到完善和改进,但食管癌和食管胃结合部腺癌的预后仍然较差。目前有数个大型临床随机对照试验数据支持对食管下端和食管胃交界部腺癌使用术前联合化疗,但辅助治疗的贡献仍不能确定。最近有meta分析表明手术联合化疗、放化疗可以提高胃食管结合部腺癌患者术后存活率,但也有一些临床随机试验的数据表明手术联合化疗、放化疗并无明显好处。本文通过总结最新的临床试验及meta分析结果,阐述不同的可切除的胃食管结合部腺癌的联合治疗方法。

By contrast with the decreasing prevalence of gastric cancer, incidence and prevalence of esophagogastric junction adenocarcinoma（EGJA） are rising rapidly. Surgical resection alone remains the standard approach for very early stage disease（stage I）, but whilst surgery remains fundamental to the treatment of stage II-III resectable adenocarcinoma, multimodality therapy with chemotherapy or chemoradiation（CRT） is internationally accepted as the standard of care. Despite improvements in surgical and radiotherapy techniques and refinements of chemotherapeutic regimens, long-term survival of esophageal cancer and esophagogastric junction adenocarcinoma remain poor. Data from several randomized phase III trials support the use of perioperative combination chemotherapy in esophagogastric junction adenocarcinomas, but the contribution of the adjuvant therapy is uncertain. There are conflicting data from randomized studies; however, recent meta-analyses have demonstrated that chemotherapy or CRT given prior to radical surgery improves survival in patients with adenocarcinoma of the oesophagus. In this review, we focus on the combined therapeutic strategies of resectable esophagogastric junction adenocarcinoma and how clinical trials and meta-analyses inform current clinical practice.