초록접수 현황
| 17F-046 | 구연 발표 |
Outcomes and Prognostic Factors of Neoadjuvant Concurrent Chemoradiotherapy followed by Esophagectomy for Thoracic Esophageal Squamous Cell Carcinoma
Hong Kwan Kim¹, Sumin Shin¹, Jong Ho Cho¹, Yong Soo Choi¹, Kwhanmien Kim², Jae Ill Zo¹, Keunchil Park³, Myung-Ju Ahn³, Jong-Mu Sun³, Yong Chan Ahn⁴, Dongryul Oh⁴, Young Mog Shim¹
¹Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea., ²Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea., ³Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea., ⁴Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Purpose : The objective of this study was to evaluate the treatment outcomes and prognostic factors of neoadjuvant concurrent chemoradiotherapy (nCCRT) followed by esophagectomy for thoracic esophageal squamous cell carcinoma (ESCC).
Methods : A retrospective review of the study cohort was performed and multivariate Cox regression analysis was used to determine the factors associated with survival outcomes.
Results : From 1996 to 2016, 391 patients underwent esophagectomy after nCCRT for thoracic ESCC. The mean age was 61 years (366 men, 94%). Most patients had clinical T3 stage (n=279, 71%) and clinical N+ stage (n=366, 94%). Surgical procedures included Ivor Lewis esophagectomy in 167 patients (43%), McKeown esophagectomy in 23 (6%), and three-field lymphadenectomy in 194 (50%). Complete resection was obtained in 360 patients (92%). Pathologic complete response (ypCR) was achieved in 97 patients (25%). Postoperative complications and in-hospital mortality occurred in 267 patients (68%) and 13 (3.3%), respectively. With a mean follow-up of 39 months, median overall survival (OS) and recurrence-free survival (RFS) were 73 months and 41 months, respectively. The 5-year OS rates were 73% in ypCR and 44% in non-ypCR (p<0.001). The 5-year RFS rates were 72% in ypCR and 38% in non-ypCR (p<0.001). Pathologic complete response, complete resection, and number of dissected lymph nodes (>20) were independent prognostic factors associated with better OS and RFS.
Conclusion : nCCRT followed by esophagectomy could be performed with acceptable early postoperative outcomes and encouraging long-term survival. Pathologically complete responders in whom tumors are completely resected by esophagectomy and adequate lymphadenectomy could achieve more favorable OS and RFS.
Methods : A retrospective review of the study cohort was performed and multivariate Cox regression analysis was used to determine the factors associated with survival outcomes.
Results : From 1996 to 2016, 391 patients underwent esophagectomy after nCCRT for thoracic ESCC. The mean age was 61 years (366 men, 94%). Most patients had clinical T3 stage (n=279, 71%) and clinical N+ stage (n=366, 94%). Surgical procedures included Ivor Lewis esophagectomy in 167 patients (43%), McKeown esophagectomy in 23 (6%), and three-field lymphadenectomy in 194 (50%). Complete resection was obtained in 360 patients (92%). Pathologic complete response (ypCR) was achieved in 97 patients (25%). Postoperative complications and in-hospital mortality occurred in 267 patients (68%) and 13 (3.3%), respectively. With a mean follow-up of 39 months, median overall survival (OS) and recurrence-free survival (RFS) were 73 months and 41 months, respectively. The 5-year OS rates were 73% in ypCR and 44% in non-ypCR (p<0.001). The 5-year RFS rates were 72% in ypCR and 38% in non-ypCR (p<0.001). Pathologic complete response, complete resection, and number of dissected lymph nodes (>20) were independent prognostic factors associated with better OS and RFS.
Conclusion : nCCRT followed by esophagectomy could be performed with acceptable early postoperative outcomes and encouraging long-term survival. Pathologically complete responders in whom tumors are completely resected by esophagectomy and adequate lymphadenectomy could achieve more favorable OS and RFS.
책임저자: Young Mog Shim
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
발표자: Hong Kwan Kim, E-mail : hkkimts@gmail.com