本期胸小星将为大家带来在高容量中心行食管切除后情况；放化疗联合免疫化疗作为不可切除局部晚期食管鳞癌转化治疗：NEXUS-1 II期试验，一起来看看吧！
2017·EATTS
01
Travel to High-Volume Centers and Survival After Esophagectomy for Cancer
Sara Sakowitz1, Syed Shahyan Bakhtiyar1 2, Saad Mallick1 3, Jane Yanagawa4, Peyman Benharash1 3
1 Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles.
2 Department of Surgery, University of Colorado, Aurora.
3 Center for Advanced Surgical & Interventional Technology, Department of Surgery, University of California, Los Angeles.
4 Division of Thoracic Surgery, Department of Surgery, University of California, Los Angeles.
Objective:
Ongoing efforts have encouraged the regionalization of esophageal adenocarcinoma treatment to high-volume centers (HVCs). Yet such centralization has been linked with increased patient travel burden and reduced postoperative continuity of care. To determine whether traveling to undergo esophagectomy at HVCs is linked with superior overall survival compared with receiving care locally at low-volume centers (LVC).
Methods:
This cohort study considered data for all patients diagnosed with stage I through III esophageal adenocarcinoma in the 2010-2021 National Cancer Database. Patients were stratified based on distance traveled to receive care and the annual esophagectomy volume at the treating hospital: the travel-HVC cohort included patients in the top 25th percentile of travel burden who received care at centers in the top volume quartile, and the local-LVC cohort represented those in the bottom 25th percentile of travel burden who were treated at centers in the lowest volume quartile. Data were analyzed from July 2023 to January 2024. The primary end points were overall survival at 1 year and 5 years. Secondary end points included perioperative outcomes and factors linked with traveling to receive care.
Results:
Of 17970 patients, 2342 (13%) comprised the travel-HVC cohort, and 1969 (11%), the local-LVC cohort. The median (IQR) age was 65 (58-71) years; 3748 (87%) were male and 563 (13%) were female. After risk adjustment and with care at local LVCs as the reference, traveling to HVC was associated with superior survival at 1 year (hazard ratio for mortality [HR], 0.69; 95% CI, 0.58-0.83) and 5 years (HR, 0.80; 95% CI, 0.70-0.90). Stratifying by stage, traveling to HVCs was associated with comparable outcomes for stage I disease but reduced mortality for stage III (1-year HR, 0.72; 95% CI, 0.60-0.87; 5-year HR, 0.83; 95% CI, 0.74-0.93). Further, traveling to HVC was associated with greater lymph node harvest (β, 5.08 nodes; 95% CI, 3.78-6.37) and likelihood of margin-negative resection (adjusted odds ratio, 1.83; 95% CI, 1.29-2.60).
Conclusion:
Traveling to HVCs for esophagectomy was associated with improved 1-year and 5-year survival compared with receiving care locally at LVCs, particularly among patients with locoregionally advanced disease. Future studies are needed to ascertain barriers to care and develop novel targeted pathways to ensure equitable access to high-volume facilities and high-quality oncologic care.
[CITATION]: Sakowitz S, Bakhtiyar SS, Mallick S, et al. Travel to High-Volume Centers and Survival After Esophagectomy for Cancer, JAMA surgery, 2024 Nov 13.
[DOI]: 10.1001/jamasurg.2024.5009
[IF]: 15.7
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在高容量中心接受食管切除术后的生存情况
胸“星”外科学术团队成员 田清源 译
目的
方法
结果
结论
Figure 2. Association of Travel to High-Volume Centers (HVCs) With Survival After Esophagectomy.
Figure 3. Stage-Stratified Association of Travel to High-Volume Centers (HVCs) With Survival.
2017·EATTS
02
Xin Wang#1, Xiaozheng Kang#2, Ruixiang Zhang#2, Liyan Xue3, Jiaqi Xu3, Xiaotian Zhao4, Qiuxiang Ou4, Nuo Yu1, Guojie Feng1, Jiao Li1, Ziyu Zheng1, Xiankai Chen2, Zhen Wang2, Qingfeng Zheng2, Yong Li2, Jianjun Qin2, Nan Bi1, Yin Li2
1 Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
2 Section of Esophageal and Mediastinal Oncology, Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
3 Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
4 Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, China.
# Contributed equally.
Background:
This phase II trial investigated the safety and efficacy of chemoradiotherapy (CRT) followed by immunochemotherapy (iCT) and surgery in unresectable locally advanced esophageal squamous cell carcinoma (ESCC).
Methods:
Patients with unresectable locally advanced ESCC received radiotherapy (50 Gy/25f, 5 days/week) and nab-paclitaxel (100 mg on day 1/week) plus cisplatin (25 mg/m2 on day 1/week) for 5 weeks, followed by tislelizumab (200 mg on day 1/cycle) plus chemotherapy (nab-paclitaxel 150 mg/m2 and cisplatin 75 mg/m2 on day 2/cycle) for two 21-day cycles. Patients who converted to resectable underwent surgery 2 to 4 weeks afterward. The primary endpoint was a 1-year progression-free survival (PFS) rate.
Results:
Thirty patients were enrolled and underwent CRT (median follow-up: 21 months), of whom 24 received iCT. Twenty (66.7%) patients achieved resectability (R0: 95.2%; pathologic complete response: 65.0%; major pathologic response: 90.0%). One-year PFS and overall survival (OS) rates were 79.4% and 89.6%, respectively. The R0 resection group exhibited longer PFS (median, not reached vs. 8.4 months; HR = 0.28; 95% confidence interval, 0.08-0.84; P = 0.02) and OS (median, not reached vs. 19.2 months; HR = 0.18; 95% confidence interval, 0.04-0.73; P < 0.01) than the nonsurgery group. Grade 3 to 4 adverse events were observed in 11 (11/30, 36.7%) patients, and immune-related pneumonitis was observed in 5 (5/24, 20.8%) patients. Post-CRT minimal residual disease before surgery was associated with unfavorable PFS and OS.
Conclusions:
Our study met the primary endpoint. Conversion CRT and subsequent iCT followed by surgery was a promising treatment strategy for unresectable locally advanced ESCC.
[CITATION]: Wang X, Kang X, Zhang R, et al. Chemoradiotherapy and Subsequent Immunochemotherapy as Conversion Therapy in Unresectable Locally Advanced Esophageal Squamous Cell Carcinoma: A Phase II NEXUS-1 Trial. Clin Cancer Res. 2024;30(22):5061-5072.
[DOI]: 10.1158/1078-0432.CCR-24-1236
[IF]:10.0
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胸“星”外科学术团队成员 涂世佳 译
背景
方法
结果
结论
Figure 3. Kaplan–Meier plots for PFS and OS. A, The Kaplan–Meier curve for PFS in all enrolled patients. B, The Kaplan–Meier curves for PFS in the R0 resection and
nonsurgery groups. C, The Kaplan–Meier curve for OS in all enrolled patients. D, The Kaplan–Meier curves for OS in the R0 resection and nonsurgery groups.
mOS, median OS; mPFS, median PFS; Ref, reference.
Table 2. AEs during therapy (n ¼ 30).
2017·EATTS
