218例食管癌根治术后复发再治疗的疗效分析  

Efficacy evaluation of rescue treatment for 218 patients with recurrent esophageal cancer after radical resection

作　　者：倪文婕 杨劲松[1] 于舒飞[1] 章文成[1] 肖泽芬[1] 周宗玫[1] 张红星[1] 陈东福[1] 冯勤付[1] 吕纪马[1] 梁军[1] 王小震[1] 王绿化[1] 殷蔚伯[1] Ni Wenjie Yang Jin-song Yu Shufei Zhang Wencheng Xiao Zefen Zhou Zongmei Zhong Hongxing Chen Dongfu Feng Qinfu Lyu Jima Liang Jun Wang Xiaozhen Wang Lyuhua Yin Weibo(Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, BeiJing 100021, China)

机构地区：[1]国家癌症中心、中国医学科学院北京协和医学院肿瘤医院放疗科,北京100021

出　　处：《中华放射肿瘤学杂志》2017年第7期744-748,共5页Chinese Journal of Radiation Oncology

摘　　要：目的 分析食管癌根治术后复发挽救治疗的疗效,为综合治疗提供依据.方法 回顾分析2004-2014年间食管癌R0术后复发转移行挽救治疗的218患者资料.采用Kaplan-Meier法计算生存率并Logrank法检验和单因素预后分析,Cox模型多因素预后分析.结果 全组患者复发后中位随访时间53个月.复发后1、3年OS率分别为57.2%、24.4%.163例局部区域复发患者复发后放化疗（40例）,单纯放疗（106例）,支持治疗（13例）的1、3年OS率分别为70%、42%,55%、24%,23%、8%（放化疗比单纯放疗P=0.045,单纯放疗比支持治疗P=0.004,单纯化疗无1年生存）.单因素分析显示术后病理N分期、TNM分期、复发后治疗方式影响预后（P均=0.001）,多因素分析中只有复发后治疗方式是影响生存的独立预后因素（P=0.013）.结论 食管癌根治术后复发转移后采用放化疗或放疗挽救治疗有明显生存获益,特别是局部区域复发患者.Objective To evaluate the efficacy of rescue treatment for recurrent esophageal cancer after radical esophagectomy, and to provide insights into the development of comprehensive treatment for esophageal cancer.Methods The clinical data of 218 patients who were confirmed with recurrent metastatic esophageal cancer after R0 resection and received rescue treatment in our hospital from 2004 to 2014 were retrospectively reviewed.The survival rate was determined by the Kaplan-Meier method.Univariate and multivariate prognostic analyses were performed using the log-rank test and Cox proportional hazards model, respectively.Results The median post-recurrence follow-up time was 53 months.The 1-and 3-year overall survival （OS） rates after recurrence were 57.2% and 24.4%, respectively.Among the 163 patients with local recurrence, the 1-and 3-year OS rates were 70% and 42% for patients treated with chemoradiotherapy （n=40）, 55% and 24% for those with radiotherapy alone （n=106）, and 23% and 8% for those with supportive therapy （n=13）（chemoradiotherapy vs.radiotherapy alone P=0.045, radiotherapy alone vs.supportive therapy P=0.004;none of the patients who were treated with chemotherapy alone survived for one year or more）.Univariate analysis showed that N staging, TNM staging, and post-recurrence rescue treatment regimen were independent prognostic factors for esophageal cancer （all P=0.001）.On the other hand, multivariate analysis indicated that only rescue treatment regimen was the independent prognostic factor for esophageal cancer （P=0.013）.Conclusions Rescue chemoradiotherapy or radiotherapy alone can bring significant survival benefits for patients with recurrent and metastatic, especially locally recurrent, esophageal cancer following radical esophagectomy.

关 键 词：肿瘤复发 食管/放射疗法 肿瘤复发 食管/化学疗法 综合治疗 预后 

分 类 号：R735.1[医药卫生—肿瘤]