不可根治性切除食管癌的计划性新辅助放疗及放化疗的疗效

摘要

Objective The role of planned neoadjuvant radiotherapy or chemoradiotherapy in the non?radical resection of esophageal squamous cell carcinoma was unclear. The study aimed to evaluate their therapeutic effect and analyze the prognostic factors. Methods We retrospectively analyzed the clinical data of locally advanced esophageal squamous cell carcinoma who received neoadjuvant radio therapy ( 33 patients) and concurrent chemoradiotherapy (119 patients) from January 2004 to December 2016 in our single?institution database.The survival rates were calculated by Kaplan?Meier method. The prognostic factors were analyzed by using Log rank test and Cox proportional hazards model. Results The median follow?up was 29.8 months. One hundred and one patients survived more than 3 years. The rates of overall survival (OS) and disease?free survival ( DFS) at 3 years were 63.9% and 55.6%, respectively.The rates of complete, partial and minimal pathological response of the primary tumor were 50.3%, 38.4%, 11.3%, the corresponding 3?year OS were 75.5%, 57.4%, 27.3%( P＜0.001) and 3?year DFS were 72.0%, 44.7%, 17.6%(P＜0.001), respectively.The postoperative lymph node metastasis rate was 27.0%. The 3?year OS and DFS of the lymph node positive group was 45.6% and 32.8%, significantly lower than 70.8% and 63.7%of the negative group (both P＜0.001).The 3?year OS and DFS of pathologic stage Ⅰ,Ⅱ,ⅢA,ⅢB andⅥ A were 76.2%, 57.4%, 64.7%, 35.0%, 33.3%( P＜0.001) and 70.1%, 49.3%, 41.2%, 22.1%, 33.3%(P＜0.001), respectively.The operation?related mortality was 3.3%. Multivariate analysis showed that chest pain, postoperative respiratory failure, pathological differentiation, more than 15 lymph node dissection and ypTNM stage were the independent prognostic factors of OS ( P＜0.05 for all). Conclusions The planned neoadjuvant radiotherapy or chemoradiotherapy for the non?radical resection of advanced esophageal squamous cell carcinoma could result in favorable survival. The chest pain, postoperative respiratory failure, pathological differentiation, the number of lymph node resection and ypTNM stage are the independent prognostic factors of the prognosis of these patients.%目的 探讨不可根治性切除局部晚期食管癌患者有计划地行新辅助放疗及放化疗的疗效和预后影响因素.方法 收集2004年1月至2016年12月就诊于中国医学科学院肿瘤医院的152例初诊局部晚期食管鳞癌患者的临床资料,其中有计划地行新辅助放疗33例,同步放化疗119例.采用Kaplan?Meier法计算生存率,采用log rank检验和Cox多因素分析模型进行预后影响因素分析.结果 全组患者的中位随访时间为29.8个月,生存时间＞3年101例,3年总生存率和3年无病生存率分别为63.9%和55.6%.原发灶重度、中度和轻度病理反应患者所占比例分别为50.3%(76／151)、38.4%(58／151)和11.3%(17／151),3年总生存率分别为75.5%、57.4%和27.3%( P＜0.001),3年无病生存率分别为72.0%、44.7%和17.6%(P＜0.001).全组患者的术后淋巴结转移率为27.0%(41／152).淋巴结阳性组和淋巴结阴性组患者的3年总生存率分别为45.6%和70.8%,3年无病生存率分别为32.8%和63.7%,差异均有统计学意义(均P＜0.001).术后病理分期为Ⅰ期、Ⅱ期、ⅢA期、ⅢB期和ⅣA期患者的3年总生存率分别为76.2%、57.4%、64.7%、35.0%和33.3%( P＜0.001),3年无病生存率分别为70.1%、49.3%、41.2%、22.1%和33.3%(P＜0.001).全组患者的手术相关死亡率为3.3%(5／152).多因素分析显示,初诊时胸背部疼痛、术后呼吸衰竭、病理分化程度、淋巴结切除＞15枚和ypTNM分期均为影响患者预后的独立因素(均P＜0.05).结论 不可根治性切除的局部晚期食管鳞癌患者行新辅助放疗及放化疗后仍可获得较好的生存时间.初诊时胸背部疼痛、术后呼吸衰竭、病理分化程度、淋巴结切除数目和ypTNM分期为患者预后的独立影响因素.