同步放化疗治疗食管癌术后复发的临床效果及预后因素分析

摘要

Objective:To assess the therapeutic outcome and prognostic factors of concurrent chemoradiotherapy ( CCRT)for recurrence of esophageal squamous cell carcinoma( SCC)after radical surgery. Methods:Treatment out-come and prognostic factors were retrospectively evaluated in 103 patients with local recurrences after radical surgery for esophageal SCC. All patients were treated with CCRT(median radiation dose 60Gy). Treatment response was eval-uated at 1~3 months after CCRT. Results:With a median follow-up of 30 months(3~103 months),the 3-year o-verall survival(OS)of all the patients was 47. 6% and the median OS time was 35. 0 months. The overall tumor re-sponse rate was 70. 9%(73/103),with a complete remission(CR)rate of 41. 7%(43/103). In univariate analysis, tumor response after CCRT(P=0. 000),time to recurrence(P=0. 028)and ECOG score(P=0. 090)showed a trend favoring better OS. Multivariate analysis revealed that tumor response after CCRT(P=0. 000)and ECOG score (P=0. 010)were independent predictors of OS. Seventy patients had progressive diseases after CCRT,39 had local failure,22 had distant metastasis and 9 had both local and distant failures. Conclusion:CCRT is effective in postoper-atively recurrent esophageal SCC. Patients that obtained complete remission after CCRT appeared to achieve long-term OS and might benefit from CCRT.%目的：分析同步放化疗治疗食管癌术后复发患者的治疗效果及预后因素。方法：回顾性分析103例食管癌术后复发患者行同步放化疗的治疗结果及预后因素。所有患者行同步放化疗，中位放疗剂量60Gy。治疗后1~3月评价肿瘤的治疗反应。结果：中位随访时间30个月（3~103月）。3年总生存率47.6％，中位存活时间35月。总体反应率70.9％（73/103），完全缓解率41.7％（43/103）。单因素分析显示同步放化疗后肿瘤的反应（P＝0.000）、至复发的时间（P＝0.028）及ECOG评分（P＝0.090），有益于总生存率，多因素分析显示同步放化疗后肿瘤的反应（P＝0.000）及ECOG评分（P＝0.010）为总生存率的独立预后因素。同步放化疗后，共70例患者出现肿瘤进展，39例局部复发，22例远处转移，9例远处转移伴局部复发。结论：同步放化疗是治疗食管癌术后复发的有效手段，治疗后取得完全缓解的患者预后较好。