食管鳞癌新辅助放化疗后复发风险分层分析

摘要

目的 探讨胸段食管鳞癌新辅助放化疗联合手术治疗后的复发风险模式,并分析术后病理分期与复发风险之间的关系.方法 回顾分析2002-2015年郑州大学附属肿瘤医院及中山大学肿瘤防治中心收治的174例局部晚期胸段食管鳞癌患者的病历资料.全组患者均采用术前同期放化疗联合手术治疗,化疗采用以铂类为基础的化疗方案,放疗剂量为40.0~50. 4 Gy,常规分割.采用Kaplan-Meier法计算生存率,Logrank检验差异,Cox模型多因素分析.结果 中位随访时间为53. 9个月,新辅助放化疗后病理完全缓解率为44. 8%,其中59例( 33. 9%)患者复发.术后病理分期为0/Ⅰ、Ⅱ、Ⅲ期患者复发率分别为22. 2%、38. 7%、68. 2%(P=0. 000),疗后5年无复发生存率分别为74. 7%、61. 4%、20. 9%(P=0. 000). 20. 5%的0/Ⅰ期或Ⅱ期患者的复发时间在术后3年以上,而Ⅲ期患者的复发时间均在2年以内.多因素分析结果显示年龄、临床分期、化疗方案、放化疗相关病理反应是影响无复发生存的因素(P=0. 027、0. 047、0. 010、0. 005).结论 胸段食管鳞癌新辅助放化疗后的病理分期与复发风险密切相关,临床医生可根据不同的病理分期制定个体化的随访监测策略.%Objective To analyze the pattern of recurrence risk and investigate the association between pathological staging and recurrence risk in patients with esophageal squamous cell carcinoma (ESCC) treated with neoadjuvant chemoradiotherapy (CRT). Methods Clinical data of 174 patients with advanced thoracic ESCC treated with neoadjuvant CRT between 2002 and 2015 were retrospectively analyzed. All patients received preoperative concurrent platinum-based chemotherapy with conformal radiotherapy (40-50. 4 Gy,conventional fractionation) combined with surgery. Kaplan-Meier method was utilized to analyze the survival,the log-rank test was conducted to compare the differences between groups,and the Cox regression model was used for multivariate analysis. Results The median follow-up time was 53. 9 months. A total of 44. 8% of patients achieved pathological complete response, and 59 patients ( 33. 9%) recurred after neoadjuvent CRT.The postoperative recurrence rate was 22. 2% for patients with pathological stage 0/I,38. 7% for stageⅡand 68. 2% for stageⅢ(P=0. 000).The 5-year recurrence-free survival (RFS) rates were 74. 7%, 61. 4% and 20. 9% for patients with pathological stage 0/Ⅰ,ⅡandⅢ,respectively (P=0. 000).In total,20. 5% of patients with pathological stage 0/I orⅡrecurred after postoperative 3 years, whereas all patients with pathological stageⅢrecurred within postoperative 2 years. Multivariate analysis demonstrated that age,clinical TNM staging,chemotherapy regimen,and pathological response after CRT were independent prognostic factors affecting the RFS ( P= 0. 027, 0. 047, 0. 010, 0. 005). Conclusions Pathological stage is significantly correlated with the recurrence risk in ESCC patients after neoadjuvant CRT.Risk-based surveillance strategies can be defined according to different pathologial staging.