pT3N0M0期胸段食管鳞癌患者术后失败原因分析及其术后放疗思考

doi:10.3760/cma.j.issn.1004-4221.2017.04.006

摘要
图/表
参考文献()
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (892 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS) 背景资料

摘要

目的探讨pT₃N₀M₀期胸段食管鳞癌患者术后失败模式,并依据其失败模式讨论术后放疗意义及可行性。方法对2007—2010年符合入组条件的227例pT₃N₀M₀期食管癌术后患者进行回顾分析,主要分析其单纯手术后失败模式,同时结合相关研究来探讨pT₃N₀M₀期胸段食管鳞癌患者术后辅助性放疗意义及适合人群。应用Kaplan-Meier法计算OS、LR、DM并Logrank法检验和单因素预后分析,Cox模型多因素预后分析。结果治疗后出现胸腔内LR 58例(25.6%),DM 27例(11.9%),其中10例为LR+DM。单纯胸腔内纵隔淋巴结复发所占比率为50%(29/58)。单因素分析显示胸上段食管癌患者术后3、5年OS率低于胸中、下段患者(P=0.000),而其胸腔-区域复发率高于后两者(P=0.047);低分化鳞癌患者3、5年OS率低于中高分化鳞癌患者(P=0.005),而其DM率高于后者(P=0.000)。多因素分析显示患者不同病变部位、不同病理分化程度为患者OS的影响因素(P=0.014、0.010);病变部位为影响患者胸腔内LR的影响因素(P=0.046);不同病理分化程度为DM的影响因素(P=0.000)。结论 pT₃N₀M₀期胸段食管鳞癌患者行常规胸腹两野根治术后胸腔内LR为其主要治疗失败模式,且胸上段食管癌高于胸中、下段食管癌患者,建议pT₃N₀M₀期胸段食管鳞癌胸上段患者行术后放疗。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	沈文斌
	高红梅
	祝淑钗
	李腾
	李曙光
	李幼梅
	刘志坤
	李娟
	苏景伟

关键词 ：食管肿瘤/外科学, 复发, 预后

Abstract：

Objective To investigate the failure mode in patients with stage pT₃N₀M₀ thoracic esophageal squamous cell carcinoma (TESCC) after surgery, and to discuss the significance and feasibility of postoperative radiotherapy according to the failure mode. Methods A retrospective analysis was performed on 227 patients with stage pT₃N₀M₀ TESCC who met the inclusion criteria from January 2007 to December 2010. Their postoperative failure mode was analyzed, and, with reference to relevant research, the significance of postoperative radiotherapy and its target patients were explored. The Kaplan-Meier method was used to calculate overall survival (OS), local recurrence (LR), and distant metastasis (DM) rates, and the log-rank test was used for survival difference analysis and univariate prognostic analysis. The Cox model was used for multivariate prognostic analysis. Results After surgery, there were 58 patients (25.6%) with LR in the thoracic cavity and 27 patients (11.9%) with DM, and 10 patients had both LR and DM. Twenty-nine (50%) of the 58 patients had recurrence in the thoracic mediastinal lymph nodes. The Results of univariate analysis showed that the 3-and 5-year OS rates of patients with upper thoracic esophageal cancer were significantly lower than those of patients with middle and lower esophageal cancer (P=0.000), and the chest-regional recurrence rate was significantly higher in the former group than in the latter two groups (P=0.047);the 3-and 5-year OS rates of patients with poorly differentiated squamous cell carcinoma were significantly lower than those of patients with moderately and well differentiated squamous cell carcinoma (P=0.005), and the DM rate was significantly higher than in the former group than in the latter two groups (P=0.000). The Results of multivariate analysis showed that lesion site and the degree of pathological differentiation were independent prognostic factors for OS (P=0.014 and 0.010);lesion site was the independent prognostic factor for chest-regional recurrence (P=0.046);the degree of pathological differentiation was the independent prognostic factor for DM (P=0.000). Conclusions For patients with stage pT₃N₀M₀ TESCC after two-field esophagectomy, the most common failure mode is chest-regional recurrence, especially in patients with upper thoracic esophageal cancer. Therefore, postoperative radiotherapy is suggested for upper-thoracic TESCC.

Key words： Esophageal neoplasms/surgery Recurrence Prognosis

收稿日期: 2016-08-31

通讯作者: 祝淑钗,Email:sczhu1965@126.com

引用本文:

沈文斌,高红梅,祝淑钗等. pT₃N₀M₀期胸段食管鳞癌患者术后失败原因分析及其术后放疗思考[J]. 中华放射肿瘤学杂志, 2017, 26(4): 394-399.

Shen Wenbin,Gao Hongmei,Zhu Shuchai et al. Analysis of postoperative failure in patients with stage pT₃N₀M₀ thoracic esophageal squamous cell carcinoma and consideration of postoperative radiotherapy　[J]. Chinese Journal of Radiation Oncology, 2017, 26(4): 394-399.

链接本文:

http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2017.04.006 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2017/V26/I4/394

[1] Rice TW,Rusch VW,Apperson-Hansen C,et al. Worldwide esophagea cancer collaboration[J].Dis Esophagus,2009,22(1):1-8.DOI:10.1111/j.1442-2050.2008.00901.x
[2] Xiao ZF,Yang ZY,Liang J,et al. Value of radiotherapy after radical surgery for esophageal carcinoma:a report of 495 patients[J].Ann Thorac Surg,2003,75(2):33l-336.DOI:10.1016/S0003-4975(02)04401-6
[3] Xiao ZF,Yang ZY,Miao YJ,et al. Influence of number of metastatic lymph nodes on survival of curative resected thoracic esophageal cancer patients and value of radiotherapy:report of 549 cases[J].Int J Radiat Oncol Biol Phys,2005,62(1):82-90.DOI:10.1016/j.ijrobp.2004.08.046
[4] Martin JT,Worni M,Zwischenberger JB,et al. The role of radiation therapy in resected T₂ N₀ esophageal cancer:a population-based analysis[J].Ann Thorac Surg,2013,95(2):453-458.DOI:10.1016/j.athoracsur.2012.08.049
[5] Chen XL,Chen TW,Fang ZJ,et al. Patterns of lymph node recurrence after radical surgery impacting on survival of patients with pT_1-3N₀M₀thoracic esophageal squamous cell carcinoma[J].J Korean Med Sci,2014,29(2):217-223.DOI:10.3346/jkms.2014.29.2.217
[6] Xu YP,Chen QX,Yu XM,et al. Factors influencing the risk of recurrence in patients with esophageal carcinoma treated with surgery:a single institution analysis consisting of 1 002 cases[J].Oncol Lett,2013,5(1):185-190.DOI:10.3892/ ol.2012.1007
[7] 杨劲松,章文成,肖泽芬,等.术后辅助3DRT改善pT₃N₀M₀期食管癌患者长期生存[J].中华放射肿瘤学杂志,2015,24(2):101-105.DOI:10.3760/cma.j.issn.1004-4221.2015.02.001.
Yang JS,Zhang WC,Xiao ZF,et al. Postoperative adjuvant three-dimensional conformal radiotherapy improves long-term survival in patients with pathological T_2-3N₀M₀ esophageal cancer[J].Chin J Radiat Oncol,2015,24(2):101-105.DOI:10.3760/cma.j.issn.1004-4221.2015.02.001
[8] 王玉祥,王丽丽,杨琼,等.pT₃N₀M₀期胸段食管鳞癌胸腹两野根治术后的复发模式[J].中华肿瘤杂志,2016,38(1):48-54.DOI:10.3760/cma.j.issn.0253-3766.2016.01.010.
Wang YX,Wang LL,Yang Q,et al. Patterns of recurrence in patients with stage pT₃N₀M₀t horacic esophageal squamous cell carcinoma after two-field esophagectomy[J].Chin J Oncol,2016,38(1):48-54.DOI:10.3760/cma.j.issn.0253-3766.2016.01.010
[9] Chen JQ,Zhu J,Pan JJ,et al. Postoperative radiotherapy improved survival of poor prognostic squamous cell carcinoma esophagus[J].Ann Thorac Surg,2010,90(2):435-442.DOI:10.1016/j.athoracsur.2010.04.002.
[10] Smit JK,Pultrum BB,van Dullemen HM,et al. Prognostic factors and patterns of recurrence in esophageal cancer assert arguments for extended two-field transthoracic esophagectomy[J].Am J Surg,2010,200(4):446-453.DOI:10.1016/j.amjsurg.2009.12.006.
[11] 张冬坤,苏晓东,林鹏,等.467例Ⅱ期胸段食管鳞癌切除术后患者的生存分析[J].癌症,2008,27(2):113-118.DOI:10.3321/j.issn:1000-467X.2008.02.001.
Zhang DK,Su XD,Lin P,et al. Survival analysis of patients with stage Ⅱ squamous cell carcinoma of the thoracic esophagus after esophagectomy[J].Chin J Cancer,2008,27(2):113-118.DOI:10.3321/j.issn:1000-467X.2008.02.001.
[12] 章文成,王奇峰,肖泽芬,等.Ⅱ和Ⅲ期胸段食管癌术后预防性三维放疗疗效分析[J].中华放射肿瘤学杂志,2012,21(2):136-139.DOI:10.3760/cma.j.issn.1004-4221.2012.02.012.
Zhang WC,Wang QF,Xiao ZF,et al. A efficacy analysis of intensity-modulated radiotherapy or three-dimensional conformal radiotherapy for resected thoracic esophageal squamous cell carcinoma[J].Chin J Radiat Oncol,2012,21(2):136-139.DOI:10.3760/cma.j.issn.1004-4221.2012.02.012.
[13] 刘晓,章文成,于舒飞,等.T_2-3N₀M₀期食管癌R₀术后失败模式分析-术后放疗潜在价值与意义[J].中华放射肿瘤学杂志,2015,24(1):19-24.DOI:10.3760/cma.j.issn.1004-4221.2015.01.006.
Liu X,Zhang WC,Yu SF,et al. Patterns of failure after radical surgery among patients with stage T_2-3N₀M₀ esophageal squamous cell carcinoma——potential value of postoperative radiotherapy[J].Chin J Radiat Oncol,2015,24(1):19-24.DOI:10.3760/cma.j.issn.1004-4221.2015.01.006.
[14] 杨劲松,刘晓,肖泽芬,等.pT_2-3N₀M₀期食管癌根治术后3DCRT前瞻性Ⅱ期临床研究[J].中华放射肿瘤学杂志,2015,24(1):29-32.DOI:10.3760/cma.j.issn.1004-4221.2015.01.008.
Yang JS,Liu X,Xiao ZF,et al. Prospective phase Ⅱ study of three-dimensional radiotherapy after radical surgery for pT_2-3N₀M₀ esophageal cancer[J].Chin J Radiat Oncol,2015,24(1):29-32.DOI:10.3760/cma.j.issn.1004-4221.2015.01.008.
[15] Guo XF,Mao T,Gu ZT,et al. Clinical study on postoperative recurrence in patients with pN₀ esophageal squamous cell carcinoma[J].J Cardiothorac Surg,2014,9:150.DOI:10.1186/s13019-014-0150-4.
[16] Gao XS,Qiao XY,Wu FP,et al. Pathological analysis of clinical target volume margin for radiotherapy in patients with esophageal and gastroesophageal junction carcinoma[J].Int J Radiat Oncol Biol Phys,2007,67(2):389-396.DOI:10.1016/j.ijrobp.2006.09.015.
[17] Liu Q,Cai XW,Wu B,et al. Patterns of failure after radical surgery among patients with thoracic esophageal squamous cell carcinoma:implications for the clinical target volume design of postoperative radiotherapy[J].PLoS One,2014,9(5):e97225.DOI:10.1371/journal.pone.0097225.
[18] Greenstein AJ,Litle VR,Swanson SJ,et al. Effect of the number of lymph nodes sampled on postoperative survival of lymph node-negative esophageal cancer[J].Cancer,2008,112(6):1239-1246.DOI:10.1016/j.jamcollsurg.2007.06.192.
[19] Rizk N,Venkatraman E,Park B,et al. The prognostic importance of the number of involved lymph nodes in esophageal cancer:implications for revisions of the American joint committee on cancer staging system[J].J Thorac Cardiovasc Surg,2006,132(6):1374-1381.DOI:10.1016/j.jtcvs.2006.07.039.
[20] Bollschweiler E,Baldus SE,Schr?der W,et al. Staging of esophageal carcinoma:length of tumor and number of involved regional lymph nodes. Are these independent prognostic factors[J]? J Surg Oncol,2006,94(5):355-363.DOI:10.1002/jso.20569.
[21] 陈龙奇,胡春燕,张合林,等.淋巴结清扫数目对进展期食管癌TNM分期和预后的影响[J].中华肿瘤杂志,2007,29(8):604-608.DOI:10.3760/j.issn:0253-3766.2007.08.011.
Chen LQ,Hu CY,Zhang HL,et al. Influence of number of removed lymph nodes on the TNM staging and survival in advanced esophageal carcinoma[J].Chin J Oncol,2007,29(8):604-608.DOI:10.3760/j.issn:0253-3766.2007.08.011.
[22] Lee J,Lee KE,Im YH,et al. Adjuvant chemotherapy with 5-fluorouracil and cisplatin in lymph node-positive thoracic esophageal squamous cell carcinoma[J].Ann Thorac Surg,2005,80(4):1170-1175.DOI:10.1016/j.athoracsur.2005.03.058.
[23] 方文涛,陈文虎,蒋勇,等.胸腹二野淋巴结清扫结合术后辅助化疗治疗食管癌[J].中华胸心血管外科杂志,2005,21(5):268-271.DOI:10.3760/cma.j.issn.1001-4497.2005.05.005.
Fang WT,Chen WH,Jiang Y,et al. Thoraco-abdominal two-field lymphadenectomy combined with adjuvant chemotherapy in the management of thoracic esophageal carcinoma[J].Chin J Thorac Cardiovasc Surg,2005,21(5):268-271.DOI:10.3760/cma.j.issn.1001-4497.2005.05.005.
[24] Rice TW,Adelstein DJ,Chidel MA,et al. Benefit of postoperative adjuvant chemoradiotherapy in locoregionally advanced esophageal carcinoma[J].J Thorac Cardiovasc Surg,2003,126(5):1590-1596.DOI:10.1016/S0022-5223(03) 01025-0.
[25] 曹秀峰,吕进,朱斌,等.局部晚期食管鳞状细胞癌术后放疗和化疗的前瞻性研究[J].中华肿瘤杂志,2010,32(6):452-455.DOI:10.3760/cma.j.issn.0253-3766.2010.06.013.
Cao XF,Lv J,Zhu B,et al. A prospective comparison between surgery alone and postoperative chemoradiotherapy for locally advanced esophageal squamous cell carcinoma[J].Chin J Oncol,2010,32(6):452-455.DOI:10.3760/cma.j.issn.0253-3766.2010.06.013.
[26] Zheng B,Zheng W,Zhu Y,et al. Role of adjuvant chemoradiotherapy in treatment of resectable esophageal carcinoma:a meta-analysis[J].Chin Med J,2013,126(6):1178-1182.
[27] Hsu PK,Huang CS,Wang BY,et al. Survival benefits of postoperative chemoradiation for lymph node-positive esophageal squamous cell carcinoma[J].Ann Thorac Surg,2014,97(5):1734-1741.DOI:10.1016/j.athoracsur.2013.12.041.