JTO: 胸中、下段食管癌的三区域和两区域淋巴结清扫术:一项随机临床试验的长期结果。

2021-03-08 MedSci原创 MedSci原创

食管癌因早期和远处淋巴结转移(LNM)而闻名。在食管癌切除术中进行根治性淋巴结清扫术的目的是减少复发并提高生存率。

食管癌因早期和远处淋巴结转移(LNM)而闻名。在食管癌切除术中进行根治性淋巴结清扫术的目的是减少复发并提高生存率。先前的试验证明,与有限范围的淋巴结清扫相比,根治性双区域(胸-腹)淋巴结清除术提高了患者的生存率,尤其是对于淋巴结阳性的患者。

对于食道癌患者来说,LNM在颈部是常见的。在日本进行的一项全国性研究报告称,与双区域淋巴结清除术相比,三区域(颈-胸-腹)淋巴结清除术(去除所有潜在阳性淋巴结)的5年生存率有所提高,因此广受欢迎。然而,由于缺乏前瞻性证据,三区域淋巴结清除术的价值尚不清楚。在全球范围研究中,只有两项随机试验比较了三个和两个领域的淋巴结清除术,但其结果相互矛盾且研究力度不足。

为了评估三区域淋巴结清除术在食管癌治疗中的作用,本文研究人员在2013年启动了一项随机试验,主要比较食管切除术中三野和两野淋巴结清除术结果。截至目前,研究人员已经完成了至少3年的随访。本研究旨在阐明三区域(颈-胸-腹)淋巴结清除术是否比两区域(胸-腹)淋巴结清除术更能提高食管癌患者的生存率。

本项研究在2013年3月至2016年11月期间,共纳入了400名中、下胸段食管癌患者并随机分配接受食管切除术,其中三区域或两区域淋巴结清除术的比例为1:1。其主要终点是总生存率(OS),计算时间从随机分组之日到因任何原因死亡之日。

两组研究的人口统计学特征相似。中位随访时间为55个月,两组患者的总生存率(HR,1.019,95%CI,0.727-1.428,P=0.912)以及无病生存率(DFS)具有可比性(HR,0.868,95%CI,0.636-1.184,P=0.371)。三区域组的5年累积OS为63%,两野组为63%;5年DFS分别为59%和53%。在这个队列中,只有晚期肿瘤阶段(pTNM阶段III-IV)被确定为OS降低的危险因素(HR,3.330,95%CI,2.140-5.183,P<0.001)。

综上所述,对于胸中、下段食管癌患者,食管切除术后三区域淋巴结清除术与二与其淋巴结清除术相比,OS或DFS没有改善。

Li, Bin et al. Esophagectomy With Three-Field Versus Two-Field Lymphadenectomy for Middle and Lower Thoracic Esophageal Cancer: Long-Term Outcomes of a Randomized Clinical Trial. Journal of Thoracic Oncology, Volume 16, Issue 2, 310 - 317

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likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿瘤克星, createdTime=Thu Feb 25 22:19:21 CST 2021, time=2021-02-25, status=1, ipAttribution=)]
    2021-04-30 MedSciZeng

    #JTO#点击进入话题查看更多相关文章 或评论时插入话题加入讨论

    0

  5. 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likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿瘤克星, createdTime=Thu Feb 25 22:19:21 CST 2021, time=2021-02-25, status=1, ipAttribution=)]
    2021-03-10 科研科研科研

    随机试验

    0

  6. 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likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿瘤克星, createdTime=Thu Feb 25 22:19:21 CST 2021, time=2021-02-25, status=1, ipAttribution=)]
    2021-02-27 sodoo
  7. 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    2021-02-27 zhouqu_8
  8. 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    2021-02-25 肿瘤克星

    高质量研究,读起来真爽,谢谢梅斯

    0

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