非手术食管鳞癌病变长度对临床分期影响——Ⅱ/Ⅲ期根治性放疗患者多中心回顾性分析(3JECROG R-01D)

摘要

Objective To retrospectively analyze the effect of tumor length on the prognosis in stage Ⅱ/Ⅲ esophageal squamous cell carcinoma (ESCC) patients treated with definitive radiotherapy and to evaluate the role of tumor length in clinical stage for non-operative ESCC patients.Methods The data of 2 086 ESCC patients who were treated with definitive radiotherapy from 2002 to 2016 in 10 hospitals (3JECROG) were analyzed.The effect of tumor length on overall survival (OS) was analyzed and stratified analysis of tumor length was done in different stages of ESCC.Results The median OS and median progression-free survival (PFS) time of the whole group were 25.6 months and 18.2 months respectively.The Cox multivariate analysis showed that treatment moda,aga,alinical stage and tumor length were independent prognostic factors.The median,1-,3-,and 5-year OS were 28.9 months,77.3％,45.0％,and 36.3％ versus 21.9 months,69.9％,37.9％,and 28.1％ for patients with ≤ 5 cm and patients ＞ 5 cm respectively (P＜0.05).For stage Ⅱ patienta,abe median OS were 42.1 and 38.9 months respectively in ≤ 5 cm group and＞5 cm group (P=0.303).And for stage Ⅲ patienta,abe median OS were 23.9 and 19.3 months respectively in ≤5 cm group and＞5 cm group (P＜0.001).The median OS with N1was 24.1 and 18.4 montha,aespectively in ≤5 cm group and＞5 cm group (P＜0.001).Conclusions The tumor length was an independent prognostic factor for stage Ⅱ/Ⅲ patients treated definitive radiotherapy.The tumor length may be helpful in clinical staging of ESCa,aspecially for stage Ⅲ and N1.%目的 回顾性分析接受根治性放疗Ⅱ、Ⅲ期食管鳞癌患者病变长度对预后的影响和在临床分期中的作用.方法 回顾分析2002-2016年全国10所医疗中心(泛京津冀食管癌协作组)符合纳入标准的2 086例不宜手术或拒绝手术而接受根治性放疗的Ⅱ、Ⅲ期食管鳞癌患者的临床及随访资料.分析中位病变长度与总生存、无进展生存的关系,进一步分层分析病变长度对临床分期的影响.结果 全组中位生存时间和中位无进展生存时间分别为25.6个月和18.2个月.Cox多因素生存分析显示治疗方式、年龄、临床分期、病变长度为预后影响因素.≤5 cm组中位生存时间28.9个月,1、3、5年生存率为77.3％、45.0％、36.3％.全组＞5 cm组中位生存时间21.9个月,1、3、5年生存率为69.9％、37.9％、28.1％(P＜0.05).Ⅱ期患者≤5 cm组和＞5 cm组中位生存时间分别为42.1个月和38.9个月(P=O.303),Ⅲ期患者的分别为23.9个月和19.3个月(P＜0.001),N1期患者的分别为24.1个月和18.4个月(P＜0.001).结论 Ⅱ、Ⅲ期食管癌患者病变长度与放疗预后相关,可能对目前临床分期具有补充作用,≤5 cm长度对Ⅲ期、N1期患者能更好的预测生存.