食管癌新辅助治疗时代关于病理反应预测与食管保留策略的思考

Thoughts on prediction of pathological response and strategies of esophageal preservation in the era of neoadjuvant therapy for esophageal cancer

近年来,新辅助治疗联合手术治疗已成为局部晚期食管癌患者标准治疗模式。新辅助治疗后病理缓解,尤其是病理完全缓解(pCR),与远期生存密切相关。新辅助治疗后部分患者临床完全缓解(cCR)。有学者提出:新辅助治疗后cCR患者或可行根治性放化疗,必要时行挽救治疗。笔者分析cCR与pCR的关系、cCR后"观察与等待"策略是否具有生存获益后认为:在cCR的基础上结合临床评估和分子诊断模型准确预测pCR,筛选合适患者,采取最佳综合处理模式,或将成为局部晚期食管癌患者个体化全程管理的重要发展方向。

In recent years, neoadjuvant treatment followed by esophagectomy has been the standard treatment strategy for locally advanced esophageal cancer. Pathological response, especially complete pathological response (pCR), indicates better overall survival. With respect to complete clinical response (cCR) after neoadjuvant treatment, some researchers propose that definitive chemoradiotherapy could be an alternative to esophagectomy. The authors analyze and summarize correlation between cCR and pCR, and survival benefits of watch and wait after cCR. The authors think cCR alone could not be the precondition for the debate, unless combined with an effective predition of pCR based on clinical and molecular biomarkers. In this way, a prudent selection of patients followed by optimal therapy could be an important direction of individual management for locally advanced esophageal cancer.