调整食管癌新辅助化疗方案周期以应对特殊时期患者手术延迟的治疗策略探讨

The possibility of neoadjuvant chemotherapy course adjustment for delayed operation of patients with esophageal cancer in special period

目的探讨调整食管癌新辅助化疗周期对患者手术的影响。方法回顾性分析2019—2020年于中国医学科学院肿瘤医院就诊,调整新辅助化疗周期(多周期化疗组)和未调整化疗周期(对照组)的食管癌患者的临床病理资料,分析两组患者的临床病理特征及术后并发症。结果多周期化疗组和对照组患者中,化疗与手术间隔时间>4周的患者分别为17和6例,差异有统计学意义(P<0.05)。多周期化疗组和对照组患者的手术平均出血量分别为88.6和46.1 ml,术后平均住院时间分别为14.7和10.0 d,差异均有统计学意义(均P<0.05)。多周期化疗组和对照组并发症发生率分别为40.9%(9/22)和31.8%(7/22),差异无统计学意义(P>0.05)。两组患者术后7 d和术后30 d均无死亡。多周期化疗组和对照组肿瘤退缩效果明显[肿瘤退缩分级(TRG)1、TRG2和TRG3级]分别为14和7例,效果不明显(TRG4级和TRG5级)分别为8和15例,差异有统计学意义(P<0.05)。多周期新辅助化疗后,有患者影像学检查提示肿瘤几乎完全消退,术后病理提示无恶性肿瘤组织残留。结论局部晚期食管癌患者增加新辅助化疗周期,可以获得更明显的肿瘤退缩反应,可根据手术排期多次调整新辅助化疗周期。

Objective To investigate the effect of the neoadjuvant chemotherapy course adjustment on the patients with esophageal cancer underwent delayed operation.Methods The clinical data of patients with esophageal cancer treated in Cancer Hospital,Chinese Academy of Medical Sciences from 2019—2020,who underwent neoadjuvant chemotherapy strategy adjustment(multiple course chemotherapy group)or not(control group),were retrospectively studied.The clinical pathological characteristics and postoperative complication of these two group were compared and analyzed.Results The cases who underwent the interval between chemotherapy and operation more than 4 weeks in multiple course chemotherapy group and control group were 17 and 6,with significant difference(P<0.05).The average operative blood loss of these two groups were 88.6 ml and 46.1 ml,the average postoperative hospital stays were 14.7 days and 10.0 days,with significant difference(P<0.05).The incidence rate of postoperative complication in the multiple course chemotherapy group was 40.9%(9/22),not significantly different from 31.8%(7/22)of control group(P>0.05).There were no death within postoperative 7 days and 30 days in both groups.Cases with apparent tumor regression[tumor regression grade(TRG)1 to 3]in multiple course chemotherapy group were 14,with marginal tumor regression(TRG 4 to 5)were 8,while there were 7 and 15 in the control group,respectively,with significant difference(P<0.05).After multiple neoadjuvant chemotherapy,the imaging examination of patients indicated an almost total tumor degradation and the postoperative pathology showed no residual malignant tumor tissue was observed.Conclusions Increased neoadjuvant chemotherapy course for patients with locally advanced esophageal cancer can obtain more obvious tumor degradation response.Neoadjuvant chemotherapy adjustment according to the operation schedule is recommended.