pT2 N0～1 M0期胸段食管鳞癌患者术后的复发规律及影响因素

摘要

Objective To retrospectively investigate the patterns of recurrence and its related factors in patients with stage pT2N0⁃1M0 thoracic esophageal squamous cell carcinoma ( ESCC) after radical resection. Methods Two hundred and twenty⁃two cases of stage pT2N0⁃1M0 thoracic ESCC treated in our hospital from 2008 to 2011 were enrolled. There were 142 males and 80 females. There were 181 cases in stage pN1 and 41 cases in stage pN1. 142 patients were treated with surgery alone and 80 with adjuvant postoperative chemotherapy ( POCT) . The diagnosis of recurrence was made primarily on the basis of CT images. Results Follow⁃up ended on Sep 30, 2014. The overall recurrence rate was 35. 1%. Locoregional recurrence (LR) was found in 25.7% of patients, distant metastasis (DM) in 5.9%, and LR plus DM in 3.6%, respectively. Locoregional recurrence accounted for about 83.3% of any recurrence, and 87.7% of the LR was in the mediastinum (91.2% of the mediastinal recurrence was located in the upper mediastinum). Multivariate Cox regression analysis showed that pN is independent factor affecting the total recurrence, LR and DM (P<0.05 for all). The total recurrence rate, LR and DM in pN1 patients were 7.1⁃, 6.5⁃and 3.1⁃fold higher than that in pN0 patients, respectively. The total risk of recurrence in females was about 49.1%of that of males. The POCT was not significantly related with the tumor recurrence ( P>0.05) . Conclusions The recurrence rate is high in patients with stage pT2N0⁃1M0 thoracic ESCC after radical resection. The most common site of recurrence is mediastinum, especially the upper mediastinum. Recurrence more frequently occurs in stage pN1 and males, and POCT could not reduce the risk of recurrence.%目的：分析pT2N0～1M0期胸段食管鳞癌根治术后的复发规律及影响因素。方法纳入2008—2011年pT2N0～1M0期胸段食管鳞癌根治术后的患者222例，其中男142例，女80例；pN0期181例，pN1期41例；单纯手术142例，术后化疗80例。术后复发诊断主要依据CT扫描结果。采用Cox比例风险回归模型分析影响患者总复发、局部区域复发（ LR）和远处转移（ DM）情况的独立影响因素。结果全组患者的总复发率为35．1％，其中LR率、DM率和LR＋DM率分别为25．7％、5．9％和3．6％。复发者中，LR者占83．3％（65／78），其中87．7％（57／65）的患者纵隔复发（上纵隔占91．2％）。Cox多因素回归分析显示，pN1期与患者的总复发、LR和DM情况均有关（均P＜0．05），女性总复发风险仅为男性的49．1％；而术后化疗与患者复发无关（ P＞0．05）。结论 pT2N0～1M0期胸段食管鳞癌患者根治术后复发率较高，且主要为纵隔复发（尤其是上纵隔）；pN1期和男性复发风险高，而术后辅助化疗未能降低复发风险。