Recent advances in multimodality treatment offer excellent opportunities to rethink the paradigm of perioperative management for locally advanced esophageal squamous cell carcinoma. One treatment clearly doesn't fit all in terms of a broad disease spectrum. Individualized treatment of local control of bulky primary tumor burden (advanced T stage) or systemic control of nodal metastatic tumor burden (advanced N stage) is essential. Given that clinically applicable predictive biomarkers are still awaited, therapy selection guided by diverse phenotypes of tumor burden (T vs. N) is promising. Potential challenges regarding the use of immunotherapy may also boost this novel strategy in the future.
近年来，多学科综合治疗的突破不断涌现，为重新审视当前局部进展期食管鳞癌围手术期治疗模式提供了新机遇。鉴于涉及食管癌分期谱广泛，临床中难以实现异病同治。针对原发肿瘤负荷（T分期较重）的局部治疗抑或转移性淋巴结负荷（N分期较重）的全身治疗，应予以辩证性个体化处理。鉴于当前缺乏实用性强的预测标志物，根据不同肿瘤负荷表型（T/N负荷相对关系），导向性选择不同疗法具有未来临床价值。尽管围手术期应用免疫治疗面临诸多潜在挑战，但这也将有助于促进未来围手术期治疗策略的优化。.