胸中段食管鳞癌根治术后辅助治疗疗效及区域复发危险因素分析  

Efficacy of adjuvant therapies and risk factors on recurrence for middle thoracic esophageal squamous cell carcinoma after radical surgery

作　　者：康梅[1] 朱礼阳 汪义纯[1] 牛励[1] 张丽[1] 吴黎明[1] 王凡[1] KANG Mei;ZHULi-yang;WANG Yi-chun;NIULi;ZHANG Li;WU Li-ming;WANG Fan(Department of Radiation Oncology,First Affiliated Hospital of Anhui Medical University,Hefei 230022,P.R.China)

机构地区：[1]安徽医科大学第一附属医院放疗科

出　　处：《中华肿瘤防治杂志》2019年第23期1783-1790,共8页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的目前胸中段食管鳞癌(middle thoracic esophageal squamous cell carcinoma,MTESCC)根治术后辅助治疗仍存在较大争议,筛选合适的人群及设计最佳的治疗方案是当前迫切需要解决的问题。本研究分析了MTESCC根治术后不同治疗方式的疗效、失败模式及影响复发的危险因素,以指导术后治疗方式,尤其是术后放疗靶区的设计。方法收集安徽医科大学第一附属医院2010-03-01-2017-10-31确诊为MTESSC并行根治性手术的213例患者资料。比较术后四种治疗方案的患者复发分布特点和生存差异(未放化疗组38例、化疗组35例、放疗组30例及放化疗组110例),并对不同局部区域的复发危险因素进行Logistic单因素及多因素回归分析,探索合理的靶区设计。结果125例(58.69%)患者出现了术后复发,且多发生在术后24个月之内。淋巴结复发最常见,以颈部及上纵隔最多。与未放化疗组相比,放疗组(χ~2=36.41,P<0.01)及放化疗组(χ~2=48.19,P<0.01)均明显降低了淋巴结复发率,主要体现在上纵隔及颈部淋巴结区。放疗组(χ~2=5.10,P=0.02)及放化疗组(χ~2=20.59,P<0.01)的无病生存率明显提高,但只有放化疗组的总生存率提高(χ~2=9.83,P<0.01),差异有统计学意义。有无术后辅助治疗(χ~2=37.35,P<0.01)、有无病理阳性淋巴结(χ~2=4.06,P=0.03)及肿瘤分化程度(χ~2=4.68,P=0.02)是影响复发的主要因素。多因素回归分析显示,术后放疗是上纵隔淋巴结复发的独立有利影响因素(OR=0.31,95%CI:0.14~0.69,P<0.01),而病理腹腔淋巴结阳性是腹腔复发的独立危险性影响因素(OR=5.21,95%CI为1.13~24.02,P=0.03)。结论胸中段食管癌术后放化疗联合仍然是最佳辅助治疗模式。病理学淋巴结阳性、肿瘤分化程度、是否放疗及化疗是影响复发的主要因素。颈部及上纵隔区是术后放疗的重点,对于术后腹腔病理淋巴结阳性患者,可能需要考虑腹腔区域放疗。OBJECTIVE Postoperative adjuvant therapies after radical surgery for the middle thoracic esophageal squamous cell cancer(MTESCC)are still controversial.It is an urgent problem to select suitable population and design the best treatment plan.This study analyzed the efficacy,failure mode and risk factors of recurrence of different treatments after MTESCC radical surgery to guide postoperative treatment,especially the design of postoperative radiotherapy target area.METHODS A total of 213 patients diagnosed as MTESSC with radical surgery from March 1st,2010 to October 31st,2017 in the First Affiliated Hospital of Anhui Medical University were collected.The recurrence characteristics and survival differences of the four treatment regimens were compared(38 in the non-chemotherapy group,35 in the chemotherapy group,30 in the radiotherapy group,and 110 in the radiotherapy and chemotherapy group),and the risk factors for recurrence in different local areas were compared.Logistic single factor and multi-factor regression analysis to explore a reasonable target area design.RESULTS Postoperative recurrence occurred in 125 patients(58.69%),mostly within24 months after operation.Lymph node recurrence is the most common cause of failure,with the neck and upper mediastinum most.Compared with the non-chemotherapy group,the radiotherapy group(χ~2=36.41,P<0.001)and the radiotherapy and chemotherapy group(χ~2=48.19,P<0.001)significantly reduced the lymph node recurrence rate,mainly in the upper mediastinum and cervical lymph node area.The disease-free survival rate was significantly improved in the radiotherapy group(χ~2=5.10,P=0.02)and the radiotherapy and chemotherapy group(χ~2=20.59,P<0.01),but the overall survival rate was only increased in the radiotherapy group(χ~2=9.83,P<0.01),the difference was statistically significant.The presence or absence of postoperative adjuvant therapy(χ~2=37.35,P<0.01),the presence or absence of pathologically positive lymph nodes(χ~2=4.06,P=0.03),and the degree of tumor differentiation(χ~2

关 键 词：食管肿瘤 放疗 复发 临床靶区 

分 类 号：R735.1[医药卫生—肿瘤]