前輔助治療前正子造影的臨床分期對食道癌術後的影響

Abstract

食道癌是目前全世界上主要的症死因之一，其五年存活率低於 15% 。鱗狀上皮細胞 癌及腺是兩種主要的食道細胞型態。在台灣，鱗狀上皮佔超過八成以病患。針對食道癌的症評估包括史、身體檢查攝影電腦斷層掃描、內視鏡超音波及正子造影檢查。食道癌的治療方式則包括化學放射線療、以及食道切除暨重建手術，而治策略的選擇則是根據開始前臨床期別來做決定。針對可切除的局部侵犯性食道癌，目前治療主要建議策略是輔助化學及放射線治療搭配食道切除手術來達成。針對這個族群的預後研究傳統上仍是 以手術 後的病理期別作為判斷依據。然而臨床上即便在治療相同患中，仍有一定的比例會疾病復發。因此在這篇研究中，我們主要探討群接受過前輔助性化學及放射線治療 搭配食道切除的手術患者中，在最初治療前正子造影檢查分期上是否 扮演 影響預後 的角色 。本研究中共收集 187 位患者，依據最初在治療前的正子造影檢 查不同分期作析，發現對於手術的病理別以及後續疾復率在統計學上有意義。此外，針對其中病理期別為 N0 的 125 位病患，同樣依據最初治療前的正子造影 檢查做分組，一樣可以發現到最初治療前的正子造影期對於後續 的疾病復發有統計 學上的意義。因此，依據研究結論我們建議將最初治療前正子造影分期納入可切除的局部侵犯性食道癌患者治療考量及追蹤計畫。

Esophageal cancer is a major cause of death worldwide and the 5 -year overall survival was less than 15%. Squamous cell carcinoma (SCC) and adenocarcinoma are the two predominant histological subtypes. In Taiwan, SCC accounted for more than 80% of all esophageal cancer. Cancer staging evaluations included medical history, physical examination, esophagogr am, computer tomography (CT), endoscopic ultrasound EUS), and positron emission tomography (PET). Treatment strategies including chemotherapy, radiotherapy, and esophagectomy with reconstruction were based on the clinical evaluation. For resectable locally advanced esophageal cancer, neoadjuvant therapy following esophagectomy was suggested. Traditionally , prognostic factors for these population were mainly focused on pathologic results. However, a certain proportion of patients with the same pathologic st age would showed different outcome. In this study, we investigated the impact of pre -CCRT PET scan (pretreatment scan) on the prognosis of patients after CCRT and esophagectomy. In analysis 187 patients enrolled in this study, N status evaluated by pretreatment PET scan (pre-CCRT PET -N) was significantly associated with pathologic N status and tumor recurrence rate. Further focused on 125 patients with pathologic N0, pre-CCRT PET -N status also showed powerful stratification in the recurrence rate and disease -free survival. Therefore, we recommended pre-CCRT PET -N status should be taken into consideration in the treatment strategies for resectable locally advanced esophageal cancer.