编者按：食管鳞癌新辅助治疗后会出现不同的治疗反应人群，而一部分患者可能在手术和检测中取得平衡。Satoru Matsuda的研究提示：pT0且无治疗前淋巴结转移的患者可能是保器官的合适候选者，当然这之前我们有很长的路要走，比如内镜对原发灶的评估，术前淋巴结转移的评估等等。
Satoru Matsuda1 、Akihiko Okamura2 、Jun Okui1 、Masashi Takeuchi1 、Hirofumi Kawakubo1 、 Hiroya Takeuchi3 、Masayuki Watanabe2 、Yuko Kitagawa1
1 Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
2 Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
3 Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Background: Efficacy of neoadjuvant chemotherapy (NAC) for resectable advanced esophageal squamous cell carcinoma (ESCC) has been improved. For the sake of surgical stress and decreased QOL after surgery, especially in aged patients, organ preservation approach might be beneficial when it is safely adopted in responders to NAC. However, for not missing chance to cure, we need to carefully select appropriate candidates.
背景：新辅助化疗（NAC）对可切除晚期食管鳞状细胞癌（ESCC）的疗效得到了改善。由于手术压力和术后生活质量下降，尤其是老年患者，安全采用保器官方法在对 NAC 应答患者中可能是有帮助的。但不要错过治愈机会，我们需要仔细选择合适的患者。
Method and results: Analysis 1; Reviewing ESCC patients who received NAC and surgery in Keio University and Cancer Institute Hospital of JFCR, the correlation between response to NAC and distribution of residual diseases were investigated. As results, postoperative recurrence in responders occurred in the regional field mostly as a solitary lesion without the distant failure, suggesting that the systemic micro metastases were eliminated and residual tumor cells could exist in long term.
方法和结果：分析1：回顾庆应义塾大学和癌症中心JFCR研究所接受NAC和手术的ESCC患者，对NAC反应与肿瘤残留分布之间的相关性进行了研究。结果，有反应者的术后复发大多发生在局部区域，表现为孤立性病变，没有远处的转移。表明全身微转移已被消除，残留肿瘤细胞可以长期存在。
Analysis 2; This study aimed to validate the distribution of residual tumors in pathological responders using a nationwide database from 85 Japanese esophageal centers. Consequently, pathological complete response (pCR) in ESCC patients with cT1/2 provided a favorable prognosis with less incidence of distant failure.
分析 2：本研究旨在利用全国范围内的数据来验证病理反应者中残留肿瘤的分布。来自 85 个日本食管中心的数据库测试了 ESCC 患者的病理完全缓解 (pCR)。cT1/2 提供了良好的预后，且远处转移的发生率较低。
Analysis 3; Focusing on the patients with pCR in the primary tumor (pT0) in the same cohort as analysis 2, factors associated with lymph node metastasis and prognosis were analyzed. This study demonstrated that disease recurrence rate in patients with pT0N0M0 was 10%. When we focused on patients with cN0M0 before NAC, 88% of patients with pT0 was pN0M0. Therefore, if patients with pT0 could be identified before surgery, patients with pT0 without pretreatment lymph node metastasis could be an appropriate candidate for organ preservation approach.
分析 3：重点关注原发肿瘤（pT0） pCR 的患者，与队列2相同，分析淋巴结转移和预后相关的因素。该研究表明pT0N0M0 患者的疾病复发率为10%。当我们关注NAC前为cN0M0的患者，88%的pT0患者为pN0M0。因此，如果术前可以识别pT0患者，那么pT0且无治疗前淋巴结转移的患者可能是保器官的合适候选者。
Analysis 4; Since endoscopic evaluation can be a reliable modality to identify responder to NAC preoperatively, the prognostic impact of endoscopic responders (ER) was investigated using nationwide data. The ER was shown to be a significant prognostic factors, while there was an interinstitutional variation.
分析 4；使用全国数据分析内镜应答者 (ER) 对预后的影响，由于内窥镜评估可能是术前识别 NAC 反应者的可靠方式。证明ER是一个重要的预后因素，同时存在机构间差异。
Conclusions: Based on the serial analyses, NAC response and pretreatment tumor progression were shown to be informative indicators to select appropriate candidate for organ preservation approach. The development of testing modalities for monitoring tumor burden is warranted to design a prospective interventional study.
结论：基于以上的系列分析，NAC 反应和治疗前肿瘤进展被证实为保器官患者选择的信息指标。有必要设计开发保器官的监测肿瘤负荷的测试模式的前瞻性干预研究。
