食管鳞癌根治性术后的复发模式及复发后再治疗的疗效分析  

Patterns of recurrence after radical surgery and efficacy of salvage therapy after recurrence in patients with esophageal squamous cell carcinoma

作　　者：宋春洋[1] 祝淑钗[1] 苏景伟[1] 李娟[1] 沈文斌[1] 高丝娜 赵彦[1] 许金蕊 李曙光[1] 李巧芳 Song Chunyang;Zhu Shuchai;Su Jingwei;Li Juan;Shen Wenbin;Gao Sina;Zhao Yan;Xu Jinrui;Li Shuguang;Li Qiaofang(Department of Radiation Oncology,Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China;Department of Nephrology,Third Hospital of Shijiazhuang,Shijiazhuang 050011,China;Department of Oncology,Hebei Pepople′s Hospital,Shijiazhuang 050011,China)

机构地区：[1]河北医科大学第四医院放疗科,石家庄050011 [2]石家庄市第三医院肾内科,050011 [3]河北省人民医院肿瘤科,石家庄050011

出　　处：《中华放射医学与防护杂志》2020年第11期840-845,共6页Chinese Journal of Radiological Medicine and Protection

摘　　要：目的评估食管鳞癌患者根治术后的复发模式并进行复发后生存时间的预后分析,寻找复发后挽救性治疗的最佳方案。方法回顾性收集河北医科大学第四医院2007年1月至2011年12月共382例食管癌根治术后区域复发接受再治疗的患者。对患者的术后复发模式及复发后生存时间的影响因素进行统计分析。单因素生存分析采用Kaplan-Meier法和Log-rank检验,多因素生存分析采用Cox回归模型。结果全组患者1、3、5年生存率分别为80.9%、35.6%、20.4%,中位生存期29.2月,中位复发时间15.0月。患者1、3、5年复发后生存率分别为37.7%、14.6%、11.9%,中位复发后生存时间10.2月。全组382例患者共观察到复发部位462个,其中锁骨上淋巴结区转移95个(20.5%),吻合口复发46个(10.0%),纵隔淋巴结区转移259个(56.1%),上腹部淋巴结区转移62个(13.4%)。接受挽救性放疗、化疗、放化疗及支持治疗的患者分别为156例、43例、82例及101例。单因素预后分析显示T分期、N分期、TNM分期、复发区域个数、复发部位及挽救性治疗方式为影响复发后生存时间的相关因素(χ^2=5.336、4.292、8.067、7.482、4.093、76.426,P<0.05)。将接受挽救性放疗的患者按中位剂量60 Gy分为<60 Gy组和≥60 Gy组,两组患者的复发后生存时间差异具有统计学意义(χ^2=8.320,P<0.05),且放疗剂量≥60 Gy组患者的复发后生存预后较优。多因素预后分析显示复发区域个数和挽救性治疗方式为复发后生存时间的独立影响因素。结论纵隔及锁骨上淋巴结转移是食管癌根治术后最常见的区域复发类型,挽救性放疗或放化疗可以更好地改善复发患者的生存预后。Objective To evaluate the recurrence patterns of esophageal squamous cell carcinoma(ESCC)after radical surgery and analyze the predictors of post-recurrence survival(PRS).Methods A total of 382 ESCC patients who developed recurrence after radical surgery were retrospectively reviewed from January 2007 to December 2011.All of them received salvage treatment after recurrence.The Univariate analysis was determined using the Kaplan-Meier method and log-rank test.Multivariate prognostic analysis was determined using the Cox proportional hazard model.Results The 1-,3-,5-year overall survival(OS)rates were 80.9%,35.6%and 20.4%,respectively.The median survival time and recurrence time were 29.2 months and 15.0 months.The 1-,3-,5-year PRS rates were 37.7%,14.6%and 11.9%,respectively.The median PRS time was 10.2 months.Locoregional recurrence was noted at 462 sites among 382 patients including 20.5%(95/462)of sites in supraclavicular LN(lymph node),10.0%(46/462)in anastomosis,56.1%(259/462)in mediastinal regional LN and 13.4%(62/462)in upper abdominal LN.There were 156,43,82 and 101 patients treated with salvage radiotherapy,chemotherapy,chemoradiotherapy and palliative care after recurrence,respectively.The univariate analysis showed that T stage,N stage,TNM stage,recurrence site,number of recurrent regions and treatment regimen after recurrence were significantly correlated with PRS(χ^2=5.336,4.292,8.067,7.482,4.093,76.426,P<0.05).Patients receiving salvage radiotherapy with the median dose of 60 Gy,were divided into<60 Gy group and≥60 Gy group.The≥60 Gy group had a better PRS than<60 Gy group(χ^2=8.320,P<0.05).Multivariate analysis showed that number of recurrent regions and treatment regimen were independent prognostic factors of PRS.Conclusions Mediastinal and supraclavicular regions were the most common sites of recurrence in ESCC patients after radical surgery.Salvage radiotherapy and chemoradiotherapy could significantly improve PRS in recurrent ESCC patients.

关 键 词：食管恶性肿瘤 根治性手术 复发 挽救性治疗 预后 

分 类 号：R735.1[医药卫生—肿瘤]