局部晚期食管鳞癌新辅助治疗后失败模式及长期生存分析  

Failure mode and long-term survival after neoadjuvant therapy for locally advanced esophageal squamous cell carcinoma

作　　者：王瑞琪 汪琳 胡晓 马红莲 裘国勤 王准 孙晓江 季永领 赖霄晶 封巍 盛李明 王跃珍 周霞 蒋友华 王长春 赵强 杨迅 刘金石 曾剑 江海涛 李浦 杜向慧 陈奇勋 徐裕金 Wang Ruiqi;Wang Lin;Hu Xiao;Ma Honglian;Qiu Guoqin;Wang Zhun;Sun Xiaojiang;Ji Yongling;Lai Xiaojing;Feng Wei;Sheng Liming;Wang Yuezhen;Zhou Xia;Jiang Youhua;Wang Changchun;Zhao Qiang;Yang Xun;Liu Jinshi;Zeng Jian;Jiang Haitao;Li Pu;Du Xianghui;Chen Qixun;Xu Yujin(Department of Thoracic Radiotherapy,the Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital),Zhejiang Key Laboratory of Radiation Oncology,Institute of Basic Medicine and Cancer(IBMC),Chinese Academy of Sciences,Hangzhou 310022,China;Wenzhou Medical University,Wenzhou 325035,China;School of Medical,Shaoxing University,Shaoxing 312000,China;Department of Thoracic Surgery,the Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital),Institute of Basic Medicine and Cancer(IBMC),Chinese Academy of Sciences,Hangzhou 310022,China;Department of Radiology,the Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital),Institute of Basic Medicine and Cancer(IBMC),Chinese Academy of Sciences,Hangzhou 310022,China;Department of Radiation Physics,the Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital),Institute of Basic Medicine and Cancer(IBMC),Chinese Academy of Sciences,Hangzhou 310022,China)

机构地区：[1]中国科学院大学附属肿瘤医院(浙江省肿瘤医院)胸部放疗科,浙江省放射肿瘤学重点实验室,中国科学院基础医学与肿瘤研究所,杭州310022 [2]温州医科大学,温州325035 [3]绍兴文理学院医学院,绍兴312000 [4]中国科学院大学附属肿瘤医院(浙江省肿瘤医院)胸外科,中国科学院基础医学与肿瘤研究所,杭州310022 [5]中国科学院大学附属肿瘤医院(浙江省肿瘤医院)放射科,中国科学院基础医学与肿瘤研究所,杭州310022 [6]中国科学院大学附属肿瘤医院(浙江省肿瘤医院)放射物理科,中国科学院基础医学与肿瘤研究所,杭州310022

出　　处：《中华放射肿瘤学杂志》2023年第4期301-306,共6页Chinese Journal of Radiation Oncology

基　　金：浙江省基础公益研究计划项目(LGF21H160005)。

摘　　要：目的探讨新辅助治疗联合手术治疗局部晚期食管鳞癌经长期随访后的失败模式。方法回顾性分析2012年9月至2019年10月于浙江省肿瘤医院行新辅助治疗联合手术治疗的238例局部晚期可切除食管鳞癌患者的临床资料,经长期随访后分析全组患者治疗后失败模式,采用Kaplan-Meier法计算全组患者总生存(OS)率、无瘤生存(DFS)率,log-rank法检验生存差异。结果全组238例患者术后病理完全缓解(pCR)率为42.0%。中位随访46.1个月,96例(40.3%)出现肿瘤进展,其中局部区域复发25例(10.5%),远处转移61例(25.6%),同时发生局部复发和远处转移10例(4.2%)。中位OS期和DFS期分别为64.7、49.9个月,3、5、7年OS率和DFS率分别为70.0%、52.8%、36.4%和63.5%、42.5%、30.0%。3、5、7年无局部区域进展生存率、无远处转移生存率分别为86.0%、71.4%、61.2%和70.6%、55.9%、43.0%。与非pCR患者相比,pCR患者的总进展率和远处转移率均较低(26.0%∶50.7%和16.0%∶32.6%,P<0.001)。pCR组3、5、7年OS率(83.0%∶60.2%、69.7%∶41.7%、50.4%∶27.7%,P<0.001),3、5、7年DFS率(80.4%∶51.4%、63.9%∶31.2%、45.9%∶20.3%,P<0.001)均显著优于非pCR组。结论远处转移是局部晚期食管鳞癌新辅助治疗后主要失败模式,术后pCR者可获得更好的长期生存。Objective To analyze the fail mode of neoadjuvant therapy combined with surgery for locally advanced esophageal squamous cell carcinoma(ESCC)after long-term follow-up.Methods Clinical data of consecutive 238 patients with locally advanced resectable ESCC who underwent neoadjuvant therapy combined with surgery in Zhejiang Cancer Hospital from September 2012 to October 2019 were retrospectively analyzed.The failure mode in the whole cohort was analyzed after long-term follow-up.The overall survival(OS)and disease free survival(DFS)rates were analyzed by Kaplan-Meier method.Survival differences were determined by log-rank test.Results The pathological complete response(pCR)rate was 42.0%in 238 patients.After a median follow-up of 46.1 months,tumor progression occurred in 96 patients(40.3%),including 25 patients(10.5%)with local recurrence,61 patients(25.6%)with distant metastases,and 10 patients(4.2%)with simultaneous local recurrence and distant metastases.The median OS and DFS were 64.7 months and 49.9 months.And the 3-,5-,and 7-year OS and DFS rates were 70.0%,52.8%,36.4%and 63.5%,42.5%,and 30.0%,respectively.The 3-,5-,and 7-year locoregional recurrence-free survival rates and distant metastasis-free survival rates were 86.0%,71.4%,61.2%and 70.6%,55.9%,43.0%.Compared with non-pCR patients,the overall progression rate and distant metastasis rate of pCR patients were lower(26.0%vs.50.7%,16.0%vs.32.6%,both P<0.05).And the 3-,5-,and 7-year OS(83.0%vs.60.2%,69.7%vs.41.7%,50.4%vs.27.7%,all P<0.001)and DFS rates(80.4%vs.51.4%,63.9%vs.31.2%,45.9%vs.20.3%,all P<0.001)were significantly better in pCR patients.Conclusions Distant metastasis is the main failure mode of patients with locally advanced ESCC after neoadjuvant therapy.Patients with postoperative pCR can achieve better long-term survival.

关 键 词：食管肿瘤 新辅助放化疗 存活率分析 病理完全缓解 

分 类 号：R735.1[医药卫生—肿瘤]