今天的文献速递内容主要有：

1.肺部重度移植物抗宿主反应可考虑进行肺移植。

2.糖尿病增加食道癌与食管胃交界处癌发病风险。

3.诱导治疗和食道切除术后淋巴结阳性的食管癌患者可进行辅助治疗。

1.

Favorable Outcome of Lung Transplantation for Severe Pulmonary Graft Versus Host Disease: An Australian Multicenter Case Series

肺部重度移植物抗宿主反应可考虑进行肺移植

BACKGROUND

Severe pulmonary chronic graft versus host disease (GVHD) is a life-threatening complication of allogeneic hematopoietic stem cell transplantation. Few treatments influence outcome, with 5-year overall survival as low as 13%. Lung transplantation (LTx) has been reported in small numbers of patients worldwide.

METHODS

We investigated the outcomes of LTx performed for this indication at 2 large Australian LTx centers.

RESULTS

Eighteen patients (aged 10-64 y; median, 29.6 y) received bilateral deceased lung transplants for pulmonary chronic GVHD between 2002 and 2017. LTx was performed at a median of 8.6 years after allogeneic stem cell transplantation (range, 2-23 y) with a median interval of 16 months from the time of transplant unit review to LTx. There were 2 early infective deaths and 3 further deaths from pulmonary infection and lung allograft rejection. There were no primary disease relapses. At a median follow-up of 5 years, the 5-year overall survival post-LTx is 80% and comparable to the Australia and New Zealand registry data of 64% for LTx performed for all indications.

CONCLUSIONS

From one of the largest series of deceased LTx for this indication, we conclude that it is a feasible option for selected patients with severe pulmonary GVHD. The outcomes appear superior to that of non-LTx-based therapies and similar to the survival of the general LTx population. Establishing guidance on referral triggers, patient eligibility, organ selection, prophylaxis of allograft rejection, and supportive care would assist hematopoietic and lung transplant units in optimizing resource allocation and patient outcomes.

Journal Transplantation

IF 4.593

摘要要点

背景 肺部慢性重度移植物抗宿主反应（chronic graft versus host disease, GVHD）是同种异体造血干细胞移植的致命并发症，至今未发现有效治疗方案，5年总生存率低至13％。

结果 作者共纳入18位接受了双侧肺移植手术的慢性GVHD患者。在异体干细胞移植后进行肺移植（Lung transplantation，LTx ）评估的中位时间间隔为16个月，进行肺移植的中位时间间隔为8.6年（2-23年）。有2位患者因肺部感染早期死亡，另有3位患者因同种异体移植排斥反应死亡。均没有原发性疾病复发。在中位时间达5年的随访中，LTx后5年总生存率明显优于当地所有适应症下LTx预后（80% vs 64%）。

结论 对于某些患有严重肺部GVHD的患者，肺移植是一个可行的选择。结果似乎优于非LTx治疗方案，并且与一般LTx人群的存活率相似。对于转诊制度、患者资格、器官选择、同种异体移植排斥反应的预防和支持治疗建立规范指南方针，将有助于骨髓移植和肺移植单位优化资源分配，改善患者预后。

DOI 10.1097/TP.0000000000002693

2.

Diabetes in relation to Barrett’s esophagus and adenocarcinomas of the esophagus: A pooled study from the International Barrett’s and Esophageal Adenocarcinoma Consortium

糖尿病增加食道癌与食管胃交界处癌发病风险

BACKGROUND

Diabetes is positively associated with various cancers, but its relationship with tumors of the esophagus/esophagogastric junction remains unclear.

METHODS

Data were harmonized across 13 studies in the International Barrett’s and Esophageal Adenocarcinoma Consortium, comprising 2309 esophageal adenocarcinoma (EA) cases, 1938 esophagogastric junction adenocarcinoma (EGJA) cases, 1728 Barrett’s esophagus (BE) cases, and 16,354 controls. Logistic regression was used to estimate study-specific odds ratios (ORs) and 95% CIs for self-reported diabetes in association with EA, EGJA, and BE. Adjusted ORs were then combined using random-effects meta-analysis.

RESULTS

Diabetes was associated with a 34% increased risk of EA (OR, 1.34; 95% CI, 1.00-1.80; I(2) = 48.8% [where 0% indicates no heterogeneity, and larger values indicate increasing heterogeneity between studies]), 27% for EGJA (OR, 1.27; 95% CI, 1.05-1.55; I(2) = 0.0%), and 30% for EA/EGJA combined (OR, 1.30; 95% CI, 1.06-1.58; I(2) = 34.9%). Regurgitation symptoms modified the diabetes-EA/EGJA association (P for interaction = .04) with a 63% increased risk among participants with regurgitation (OR, 1.63; 95% CI, 1.19-2.22), but not among those without regurgitation (OR, 1.03; 95% CI, 0.74-1.43). No consistent association was found between diabetes and BE.

CONCLUSIONS

Diabetes was associated with increased EA and EGJA risk, which was confined to individuals with regurgitation symptoms. Lack of an association between diabetes and BE suggests that diabetes may influence progression of BE to cancer.

Journal Cancer

IF 6.102

摘要要点

背景 糖尿病可增加多种癌症患病风险，但它与食道或食管胃交界处肿瘤的关系仍不清楚。

方法 作者共纳入2309例食管腺癌（esophageal adenocarcinoma, EA），1938例食管胃交界处腺癌（esophagogastric junction adenocarcinoma, EGJA），1728例 Barrett食管（Barrett’s esophagus, BE）和16,354例对照组。

结果 糖尿病可增加34％EA风险（OR 1.34）；EGJA为27％（OR 1.27）；EA+EGJA为30％（OR 1.30）。反流的存在可增强糖尿病与EA +EGJA的关联，有反流的糖尿病患者致癌风险增加63％（OR 1.63），但是无反流的糖尿病患者致癌风险大幅度降低（OR 1.03）。在糖尿病和BE之间未发现一致关联。

结论 糖尿病与EA和EGJA风险增加有关，存在反流的患者更甚。糖尿病与BE之间缺乏关联，表明糖尿病可能会影响BE向癌症的发展进程。

DOI 10.1002/cncr.32444

3.

Adjuvant Therapy for Node-Positive Esophageal Cancer After Induction and Surgery: A Multisite Study

诱导治疗和食道切除术后淋巴结阳性的食管癌患者可进行辅助治疗

BACKGROUND

The benefit of adjuvant treatment for esophageal cancer patients with positive lymph nodes after induction therapy and esophagectomy is uncertain. This in-depth multicenter study assessed the benefit of adjuvant therapy in this population.

METHODS

A retrospective cohort study from 9 institutions included patients who received neoadjuvant treatment, underwent esophagectomy from 2000 to 2014, and had positive lymph nodes on pathology. Factors associated with administration of adjuvant therapy were assessed using multilevel random-intercept modeling to account for institutional variation in practice. Kaplan-Meier analyses were performed based on adjuvant treatment status. Variables associated with survival were identified using Cox proportional hazards modeling.

RESULTS

The study analyzed 1082 patients with node-positive cancer after induction therapy and esophagectomy: 209 (19.3%) received adjuvant therapy and 873 (80.7%) did not. Administration of adjuvant treatment varied significantly from 3.2% to 50.0% between sites (P < .001). Accounting for institution effect, factors associated with administration of adjuvant therapy included clinically positive and negative prognostic characteristics: younger age, higher pathologic stage, pathologic grade, no neoadjuvant radiotherapy nonsmoking status, and absence of postoperative infection. Kaplan-Meier analysis showed patients receiving adjuvant therapy had a longer median survival of 2.6 years vs 2.3 years (P = .02). Cox modeling identified adjuvant treatment as independently associated with improved survival, with a 24% reduction in mortality (hazard ratio, 0.76; P = .005).

CONCLUSIONS

Adjuvant therapy was associated with improved overall survival. Therefore, consideration should be given to administration of adjuvant therapy to esophageal cancer patients who have persistent node-positive disease after induction therapy and esophagectomy and are able to tolerate additional treatment.

Journal Ann Thorac Surg

IF 3.919

摘要要点

背景 诱导治疗和食道切除术后淋巴结阳性的食管癌患者是否能从辅助治疗中获益尚不明确。

方法：作者纳入1082例经诱导治疗和食管切除术后淋巴结阳性的患者，其中209例（19.3％）接受了辅助治疗，873例（80.7％）未接受辅助治疗。

结果 不同机构进行辅助治疗的概率有显著差异（3.2％-50.0％）。与进行辅助治疗的相关因素包括：年龄较小、病理分期较高、病理分级、无新辅助放疗、非吸烟状态以及术后无感染。研究显示接受辅助治疗的患者中位生存期更长（2.6年 vs 2.3年）。此外辅助治疗是改善生存率的独立相关因素，死亡率可降低24％（危险比 0.76）。

结论 辅助治疗与改善总生存期有关。因此应考虑对诱导治疗和食管切除术后出现持续淋巴结阳性的食道癌患者在可耐受的范围内进行辅助治疗。

DOI 10.1016/j.athoracsur.2019.04.099