Therapeutic efficacy of different adjuvant modalities in thoracic esophageal squamous cell carcinoma
Shen Wenbin,Gao Hongmei,Zhu Shuchai,Li Teng,Li Shuguang,Li Youmei,Liu Zhikun,Su Jingwei,Li Juan
Department of Radiation Oncology,The Forth Hospital,Hebei Medical University,Shijiazhuang 050011,China (Shen WB,Zhu SC,Li T,Li SG,Li YM,Liu ZK,Su JW,Li J);Department of Radiation,The First Hospital of Shijiazhuang,Shijiazhuang 050011,China;Department of Radiology,First Hospital of Shijiazhuang,Shijiazhuang 050012,China (Gao HM)
Abstract： Objective To evaluation and comparison the curative effect of different adjuvant therapy and prognostic factors with thoracic esophageal squamous cell carcinoma (ESCC) after surgery,and to find the best treatment for them. Methods A total of 863 patients with thoracic ESCC underwent surgery in the fourth hospital of Hebei Medical University,From January 2007 to December 2010,To analyze the influence factors of the patient′s independent prognosis and the effect of postoperative adjuvant therapy on the prognosis of patients. The 1:1, after the tendency of a total of 261 cases were used PSM method (87 cases/group).The Kaplan-Meier method was used to calculate OS,DFS and log-rank test and monovariable analysis,Cox model was used to multivariable analysis. Results The sample size in 1,3,5 was 123,589,863 cases. The 1-,3-,and 5-year overall survival (OS) and disease-free survival (DFS) of all patients were 89.7%,62.1%,51.7% and 76.8%,52.1%,44.2%,respectively. The 1,3,5-years of OS and DFS were 956%,73.3%,61.1% and 85.6%,61.1%,54.4%,78.9%,38.9%,31.3% and 67.8%,27.8%,20.0%,92.2%,55.6%,44.4% and 67.8%,44.4%,36.7%(all P=0.000) among postoperation chemoradiotherapy (POCRT),postoperation chemotherapy (POCT) and postoperation radiotherapy (PORT) after pairing with PSM.The result of COX analysis showed that the degree of inflammatory adhesion,pTNM stage and the number of positive lymph nodes were the independent prognostic factors in patients with OS (P=0.002,0.000,0.007).The history of drinking,pTNM stage and treatment model were the independent prognostic factors of DFS (P=0.009,0.000,0.012). Conclusions Patients with thoracic esophageal squamous cell carcinoma after surgery to receive adjuvant therapy has a good effect,compared with PORT and POCT,POCRT can significantly improve the OS and DFS,and POCRT was the independent prognostic factors of DFS.
Shen Wenbin,Gao Hongmei,Zhu Shuchai et al. Therapeutic efficacy of different adjuvant modalities in thoracic esophageal squamous cell carcinoma [J]. Chinese Journal of Radiation Oncology, 2017, 26(7): 737-743.
[1] Fujiwara Y,Yoshikawa R,Kamikonya N,et al. Trimodality therapy of esophagectomy plus neoadjuvant chemoradiotherapy improves the survival of clinical stage Ⅱ/Ⅲ esophageal squamous cell carcinoma patients[J].Oncol Rep,2012,28(2):446-452.DOI:10.3892/or.2012.1847. [2] 祝淑钗,宋长亮,沈文斌,等.食管癌根治性切除术后患者预后的影响因素分析[J].中华肿瘤杂志,2012,34(4):281-286.DOI:10.3760/cma.j.issn.0253-3766.2012.04.010. Zhu SC,Song CL,Shen WB,et al. Prognostic analysis of clinicopathological factors in patients after radical resection of esophageal carcinoma[J].Chin J Oncol,2012,34(4):281-286.DOI:10.3760/cma.j.issn.0253-3766.2012.04.010. [3] 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/OL].PLoS One,2014,9(5):e97225.DOI:10.1371/journal.pone.0097225. [4] Hong JC,Murphy JD,Wang SJ,et al. Chemoradiotherapy before and after surgery for locally advanced esophageal cancer:a SEER-Medicare analysis[J].Ann Surg Oncol,2013,20(12):3999-4007.DOI:10.1245/s10434-013-3072-9. [5] Bystricky B,Okines AFC,Cunningham D.Optimal therapeutic strategies for resectable oesophageal or oesophagogastric junction cancer[J].Drugs,2011,71(5):541-555.DOI:10.2165/11585460-000000000-00000. [6] Schreiber D,Rineer J,Vongtama D,et al. Impact of postoperative radiation after esophagectomy for esophageal cancer[J].J Thorac Oncol,2010,5(2):244-250.DOI:10.1097/JTO.0b013e3181c5e34f. [7] 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):331-336.DOI:10.1016/S0003-4975(02)04401-6. [8] 康静静,惠周光,肖泽芬,等.食管癌术后放疗同步紫杉醇+奈达铂方案化疗的初探[J].中华放射肿瘤学杂志,2016,26(5):571-575.DOI:10.3760/cma.j.issn.1004-4221.2016.06.006. Kang JJ,Hui ZG,Xiao ZF,et al. Postoperative radiotherapy combined with concurrent paclitaxel-nedaplatin chemotherapy for esophageal cancer:a preliminary study[J].Chin J Radiat Oncol,2016,26(5):571-575.DOI:10.3760/cma.j.issn.1004-4221.2016.06.006. [9] 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. [10] 杨劲松,刘晓,肖泽芬,等.pT2-3N0M0期食管癌根治术后3DRT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 pT2-3N0M0 esophageal cancer[J].Chin J Radiat Oncol,2015,24(1):29-32.DOI:10.3760/cma.j.issn.1004-4221.2015.01.008. [11] Macdonald JS,Smalley SR,Benedetti J,et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction[J].N Engl J Med,2001,345(10):725-730.DOI:10.1056/NEJMoa010187. [12] Ténière P,Hay JM,Fingerhut A,et al. Postoperative radiation therapy does not increase survival after curative resection for squamous cell carcinoma of the middle and lower esophagus as shown by a multicenter controlled trial[J].Surg Gynecol Obstet,1991,173(2):123-130. [13] 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. [14] 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. [15] Bédard ELR,Inculet RI,Malthaner RA,et al. The role of surgery and postoperative chemoradiation therapy in patients with lymph node positive esophageal carcinoma[J].Cancer,2001,91(12):2423-2430.DOI:10.1002/1097-0142(20010615)91:12<2423::AID-CNCR1277>3.0.CO;2-1. [16] Rice TW,Blackstone EH,Adelstein DJ,et al. N1 esophageal carcinoma:the importance of staging and downstaging[J].J Thorac Cardiovasc Surg,2001,121(3):454-464.DOI:10.1067/mtc.2001.112470. [17] Eloubeidi MA,Desmond R,Arguedas MR,et al. Prognostic factors for the survival of patients with esophageal carcinoma in the U.S.:the importance of tumor length and lymph node status[J].Cancer,2002,95(7):1434-1443.DOI:10.1002/cncr.10868. [18] Godfrey TE,Raja S,Finkelstein SD,et al. Prognostic value of quantitative reverse transcription-polymerase chain reaction in lymph node-negative esophageal cancer patients[J].Clin Cancer Res,2001,7(12):4041-4048. [19] Hosch S,Kraus J,Scheunemann P,et al. Malignant potential and cytogenetic characteristics of occult disseminated tumor cells in esophageal cancer[J].Cancer Res,2000,60(24):6836-6840. [20] Chen JQ,Pan JJ,Liu J,et al. Postoperative radiation therapy with or without concurrent chemotherapy for node-positive thoracic esophageal squamous cell carcinoma[J].Int J Radiat Oncol Biol Phys,2013,86(4):671-677.DOI:10.1016/j.ijrobp.2013.03.026.
2017, Vol. 26 
