局部晚期食管鳞癌新辅助放化疗联合手术治疗的临床疗效分析  

Clinical efficacy of neoadjuvant chemoradiotherapy followed by surgery for locally advanced esophageal squamous cell carcinoma

作　　者：刘施亮 习勉[1] 杨雅迪[2] 赵磊[1] 傅剑华[3] 刘孟忠[1] 

机构地区：[1]华南肿瘤学国家重点实验室中山大学肿瘤防治中心放疗科,广州510060 [2]华南肿瘤学国家重点实验室中山大学影像介入中心,广州510060 [3]华南肿瘤学国家重点实验室中山大学肿瘤防治中心胸外科,广州510060

出　　处：《中华放射肿瘤学杂志》2015年第3期232-236,共5页Chinese Journal of Radiation Oncology

摘　　要：目的 探讨新辅助放化疗联合手术治疗局部晚期食管鳞癌的临床疗效,并分析临床完全缓解率（cCR）与病理完全缓解率（pCR）的关系.方法 回顾性选取2001-2013年局部晚期胸段食管鳞癌患者158例,全组均采用术前同期放化疗联合手术方式,化疗采用以铂类为基础化疗方案,放疗剂量为40 Gy,2.0 Gy/次,5次/周.Kaplan-Meier法计算OS和DFS,Logrank法检验并单因素预后分析,Cox模型多因素预后分析.结果 全组患者的pCR率为41.1％.新辅助放化疗后44例cCR患者中32例（73％）达pCR,114例非cCR患者中33例（28.9％）达pCR （P =0.000）.cCR预测pCR的敏感性、特异性分别为49.2％、87.1％,阳性、阴性预测值分别为72.7％、71.1％.3年总样本数为53例.全组3年OS、DFS分别为53.9％、48.6％,cCR的显著高于非cCR的（P=0.012、P=0.026）,pCR的显著高于非pCR的（P =0.000、0.000）.多因素分析显示放化疗后病理反应和化疗方案是影响OS的因素.最常见≥3级急性不良反应为白细胞减少（34.2％）.结论 新辅助放化疗联合手术治疗局部晚期食管鳞癌可获得较高pCR率且不良反应可耐受,放化疗后cCR率与pCR率、OS密切相关.Objective To explore the efficacy of neoadjuvant chemoradiotherapy （CRT） followed by surgery for locally advanced esophageal squamous cell carcinoma （ESCC）,and to investigate the correlation between a clinical complete response （cCR） and a pathologic complete response （pCR）.Methods One hundred and fifty-eight patients with locally advanced thoracic ESCC from 2001 to 2013 were retrospectively analyzed.All patients received concurrent chemoradiotherapy followed by surgery.Platinumbased chemotherapy regimens were adopted in chemotherapy and a prescribed dose of 40 Gy in 20 fractions,5 fractions per week,was used in radiotherapy.The overall survival （OS） and disease-free survival （DFS） rates were calculated using the Kaplan-Meier method,and pairwise comparisons and univariate prognostic analyses were performed using the log-rank test.Multivariable prognostic analyses were performed using the Cox regression model.Results The pCR rate was 41.1% in all patients.After the treatment with neoadjuvant CRT,32（72.7%） out of 44 patients with a cCR had a pCR,but only 33（28.9%） out of 114 patients with a non-cCR had a pCR （P =0.000）.The sensitivity,specificity,positive predictive value,and negative predictive value of a cCR in predicting a pCR were 49.2%,87.1%,72.7%,and 71.1%,respectively.The 3-year sample size was 91.The 3-year OS and DFS rates in all patients were 53.9% and 48.6%,respectively.Patients with a cCR had significantly higher 3-year OS and DFS rates than those with a non-cCR （P =0.012;P =0.026）,while patients with a pCR had significantly higher 3-year OS and DFS rates than those with a non-pCR （P =0.000;P =0.000）.The multivariate analyses demonstrated that the pathologic response after CRT and chemotherapy regimen were the influencing factors for OS.The most common grade ≥3 acute adverse reaction was leucopenia （34.2%）.Conclusions With a high pCR rate and tolerable adverse reactions,neoadjuvant CRT followed by surgery is a safe and effective option for locally advanc

关 键 词：食管肿瘤/新辅助放化疗法 临床完全缓解 病理完全缓解 预后 

分 类 号：R735.1[医药卫生—肿瘤]