Background/Objectives: Esophageal cancer (EC) remains highly lethal. The standard management of locally advanced disease includes neoadjuvant chemoradiotherapy (nCRT) followed by surgery. However, the role of esophagectomy in patients achieving clinical complete response (cCR) after nCRT remains uncertain. Methods: We conducted a retrospective study at the Davidoff Cancer Center, Rabin Medical Center (2013–2023). Patients with thoracic EC (adenocarcinoma and squamous cell carcinoma) stage cT2–4a, N+, M0 who received nCRT (cisplatin/5-FU or CROSS regimen with 41.4–50.4 Gy) were included. Patients with cCR, defined by negative biopsies, endoscopic ultrasound, and PET-CT, were managed with surgery or surveillance. Survival was analyzed using Kaplan–Meier and Cox regression. Results: Of 252 patients treated with nCRT, 118 achieved cCR. Seventy underwent surgery, with 47% (33 patients) achieving pathological complete response (pCR), and 48 were managed with surveillance. Five-year overall survival (OS) was 48% with surveillance and 49% with surgery; disease-free survival (DFS) was 36% vs. 43%. No significant differences were observed in OS (HR = 0.75, 95% CI 0.47–1.26) or DFS (HR = 0.88, 95% CI 0.55–1.41). In patients ≤70 years, surgery conferred an OS and DFS benefit (HR = 0.44,p= 0.03). No benefit was observed in patients >70 years, where outcomes trended against surgery. On multivariable analysis, older age (p= 0.005) and female sex (p= 0.007) were independent predictors of OS. Conclusions: In younger patients (≤70 years), surgery yielded significant survival benefit, supporting its role as the preferred treatment. In patients >70 years, surveillance produced comparable or superior outcomes, suggesting deferral of surgery may avoid morbidity without compromising survival. Age-specific tailoring of management is essential.
背景/目的：食管癌（EC）的致死率仍然很高。局部晚期疾病的标准治疗方案包括新辅助放化疗（nCRT）后进行手术。然而，对于在nCRT后达到临床完全缓解（cCR）的患者，食管切除术的作用仍不明确。方法：我们在拉宾医疗中心Davidoff癌症中心（2013–2023年）进行了一项回顾性研究。研究对象为临床分期cT2–4a、N+、M0的胸段食管癌（腺癌和鳞状细胞癌）患者，这些患者均接受了nCRT（顺铂/5-FU或CROSS方案，剂量为41.4–50.4 Gy）。达到cCR（定义为活检、超声内镜和PET-CT结果均为阴性）的患者接受手术或监测随访。采用Kaplan–Meier法和Cox回归分析生存情况。结果：在252例接受nCRT治疗的患者中，118例达到cCR。其中70例接受了手术，47%（33例）达到病理完全缓解（pCR）；48例接受监测随访。监测组的5年总生存率（OS）为48%，手术组为49%；无病生存率（DFS）分别为36%和43%。两组在OS（HR = 0.75，95% CI 0.47–1.26）或DFS（HR = 0.88，95% CI 0.55–1.41）方面均未观察到显著差异。在≤70岁的患者中，手术带来了OS和DFS的获益（HR = 0.44，p= 0.03）。而在>70岁的患者中未观察到手术获益，且结果有不利于手术的趋势。多变量分析显示，年龄较大（p= 0.005）和女性（p= 0.007）是OS的独立预测因素。结论：对于较年轻患者（≤70岁），手术可带来显著的生存获益，支持其作为首选治疗方案。对于>70岁的患者，监测随访可获得相当或更优的结果，提示推迟手术可能在不影响生存的情况下避免并发症。因此，根据年龄个体化制定治疗方案至关重要。
肿瘤(癌症)患者之家