从复发方式看食管癌新辅助治疗的内在机制

Patterns of recurrence after neoadjuvant chemoradiotherapy compared with surgery alone in esophageal cancer

新辅助治疗作为进展期食管癌患者的标准治疗,明显改善了患者的远期预后。但不可忽视的是,仍有近一半的接受新辅助治疗的患者在术后2年内出现复发,成为当前食管癌诊疗的瓶颈,导致5年总体生存率仍不容乐观。因此,了解食管癌复发模式,特别是深究新辅助治疗与单纯手术在复发模式上的异同,解析新辅助治疗发挥作用的内在机制及其局限性,对于制定有效的随访策略和进一步提高疗效非常重要。综合分析当前相关临床研究结果可以发现,新辅助治疗并未改变食管癌患者的复发方式,其以远处转移为主,新辅助治疗的主要效果是降低局部复发率,对于远处转移的控制效果轻微,这可能是新辅助治疗即便显著有效,但患者的远期生存仍旧差强人意的内在机制。

Associated with improvement in survival,the neoadjuvant therapy had become the mainstay of therapy for patients with locally advanced esophageal cancer.Despite a significantly better survival,the recurrence risk after neoadjuvant therapy remains considerably high,with recurrence rate of>40%.Thus,it′s important to gain a thorough understanding of the recurrence patterns for developing effective tertiary prevention and follow-up strategies.The aim of this review was to compare the patterns of recurrence in patients with esophageal cancer who received preoperative therapy followed by surgery or surgery alone.It is found that the most frequent recurrence pattern was distant metastasis in esophageal cancer regardless receipt of neoadjuvant therapy or not,and the major effect of neoadjuvant therapy appears to be an improvement in local regional disease control without a reduction in systemic.This frustrating fact may explain the poor survival of esophageal cancer patients receiving neoadjuvant therapy.