颈段和胸上段食管鳞状细胞癌术后辅助化疗的预后意义  

Prognostic value of postoperative adjuvant chemotherapy in patients with cervical and upper thoracic esophageal squamous cell carcinoma

作　　者：郭康 马洁 朱建飞 白峻峰 王武平 卢强 赵晋波 闫小龙 汪健 李文海 李小飞 GUO Kang;MA Jie;ZHU Jianfei;BAI Junfeng;WANG Wuping;LU Qiang;ZHAO Jinbo;YAN Xiaolong;WANG Jian;LI Wenhai;LI Xiaofei(Chest Hospital,Xi'an International Medical Center Hospital,Xi'an,710100,P.R.China;Department of Thoracic Surgery,Tangdu Hospital,Air Force Military Medical University,Xi'an,710038,P.R.China)

机构地区：[1]西安国际医学中心医院胸科医院,西安710100 [2]空军军医大学唐都医院胸腔外科,西安710038

出　　处：《中国胸心血管外科临床杂志》2022年第12期1580-1586,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨术后辅助化疗能否给上段(颈段及胸上段)食管鳞状细胞癌(鳞癌)患者带来生存获益。方法回顾性分析2006—2010年唐都医院胸腔外科连续收治的行R0切除并行颈部吻合颈段及胸上段食管鳞癌患者的临床资料。排除接受新辅助治疗或辅助放疗的患者,纳入接受辅助化疗的患者(手术+辅助化疗组)和非辅助化疗患者(单纯手术组)。术后辅助化疗给予紫杉醇类+铂类两药联合治疗;非辅助化疗患者术后未接受其它抗肿瘤治疗。采用Kaplan-Meier法分析两组患者的生存差异。结果共纳入181例患者,其中男141例(77.9%)、女40例(22.1%),平均年龄(61.0±8.2)岁(≤61岁:80例,>61岁:101例)。颈段食管鳞癌70例(38.7%)、胸上段食管鳞癌111例(61.3%)。接受术后辅助化疗的患者有87例(48.1%)、单纯手术未接受辅助化疗的患者有94例(51.9%)。两组患者基线特征一致性较好(P>0.05)。手术+辅助化疗组和单纯手术组上段食管鳞癌患者中位生存时间分别为31.93个月和26.07个月,5年生存率分别为35.0%和32.0%,生存曲线有差异趋势,但差异无统计学意义(P=0.227)。颈段和胸上段食管鳞癌患者的中位生存时间差异无统计学意义(31.83个月vs.29.76个月,P=0.763)。颈段食管鳞癌手术+辅助化疗组中位生存时间为45.07个月,单纯手术组的中位生存时间为14.70个月,生存曲线有差异趋势,但差异无统计学意义(P=0.074)。进一步分析上段食管鳞癌手术预后:淋巴结阴性组的中位生存时间为32.53个月,淋巴结阳性组为24.57个月(P=0.356)。淋巴结阳性术后行辅助化疗患者中位生存时间为30.43个月,单纯手术患者为17.77个月,生存曲线有差异趋势,但差异无统计学意义(P=0.557)。结论颈段和胸上段食管鳞癌患者行R0切除后远期生存差异无统计学意义。相对胸上段食管鳞癌,术后辅助化疗可能会给颈段食管鳞癌患者带来生存获益;辅助化疗对于术后淋巴结�Objective To explore whether surgery combined with adjuvant chemotherapy can bring survival benefits to patients with cervical and upper thoracic esophageal squamous cell carcinoma(ESCC).Methods The clinical data of patients with cervical and upper thoracic ESCC who underwent R0 resection and neck anastomosis in our department from 2006 to 2010 were retrospectively analyzed.Patients received neoadjuvant therapy or adjuvant radiotherapy were excluded.The adjuvant chemotherapy group was given a combination of taxanes and platinum based chemotherapy after surgery;the surgery alone group did not receive adjuvant chemotherapy.The Kaplan-Meier method was used to analyze the survival difference between the adjuvant chemotherapy group and the surgery alone group.Results A total of 181 patients were enrolled,including 141(77.9%)males and 40(22.1%)females,with an average age of 61.0±8.2 years(80 patients aged≤61 years,101 patients aged>61 years).There were 70(38.7%)patients of cervical ESCC,and 111(61.3%)patients of upper thoracic ESCC.Eighty-seven(48.1%)patients underwent postoperative adjuvant chemotherapy,and 94(51.9%)patients underwent surgery alone,and the basic clinical characteristics were well balanced between the two groups(P>0.05).The median survival time of patients in the adjuvant chemotherapy group and the surgery alone group was 31.93 months and 26.07 months,and the 5-year survival rate was 35.0%and 32.0%,respectively(P=0.227).There was no statistical difference in median survival time between the cervical ESCC and upper thoracic ESCC group(31.83 months vs.29.76 months,P=0.763).For cervical ESCC patients,the median survival time was 45.07 months in the adjuvant chemotherapy group and 14.70 months in the surgery alone group(P=0.074).Further analysis showed that the median survival time of lymph node negative group was 32.53 months,and the lymph node positive group was 24.57 months(P=0.356).The median survival time was 30.43 months in the lymph-node positive group with adjuvant chemotherapy and 17.77 months

关 键 词：颈段食管鳞状细胞癌 胸上段食管鳞状细胞癌 手术 辅助化疗 预后 

分 类 号：R735.1[医药卫生—肿瘤]