Ⅲ期胸段食管鳞癌根治术后辅助治疗价值

doi:10.3760/cma.j.issn.1004-4221.2017.01.005

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Abstract

Objective To retrospectively analyze the value of postoperative adjuvant therapy in the treatment of stage Ⅲ thoracic esophageal squamous cell carcinoma (ESCC). Methods From 2008 to 2011,a total of 395 patients with stage Ⅲ thoracic ESCC undergoing radical resection were enrolled as subjects. In those patients.97 received surgery alone (S).212 postoperative adjuvant chemotherapy (POCT),and 86 postoperative radiotherapy (PORT).Comparison of categorical data was made by chi-square test. The survival rates were calculated by the Kaplan-Meier method. The log-rank test was used for between-group comparison and univariate analysis. Results All patients were followed up for at least 3 years.125 cases were followed up for at least 5 years. The 5-year overall survival (OS) rates in patients treated with S,POCT and PORT were 17.1%,29.2% and 36.4%,respectively (P=0.000).POCT and PORT could mainly increased OS in patients of males.upper-and middle-segment,severe ahhesion at surgery.well-or middle-differentiation,stage Ⅲ_aand Ⅲ_b(P=0.000-0.049);whenever ages.tumor lesion,two-/three field esophagectomy.and th e number of removal lymph nodes. PORT could improved OS also (P=0.001-0.047).POCT could also improve OS in patients of ages≤60,tumor lesion<6 cm and removal lymph nodes<10(P=0.002-0.049).The 5-year progression-free survival (PFS) were 19.0% with S,28.8% with POCT,36.4% with PORT,respectively (P=0.012).PORT could improve PFS (P=0.012);especially for patients of males,ages ≤60,upper-and middle segment ESCC,tumor lesion ≥6 cm,severe ahhesion at surgery,removal lymph node<10 and ≥10,well or middle differentiation,stage Ⅲ_a and Ⅲ_b(P=0.001-0.042).But POCT could not increased PFS (P=0.119). Conclusions In the treatment of patients with stage Ⅲ thoracic ESCC undergoing radical resection,both POCT and PORT can improve the OS rate,particularly in patients with stage Ⅲ_a or Ⅲ_b middle and upper thoracic ESCC,severe adhesion formation during surgery.and moderately or well differentiated squamous cell carcinoma. The DFS rate is improved in patients treated with PORT,but not in those treated with POCT.

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	Articles by authors
	Wang Yuxiang
	Yang Qiong
	Qiu Rong
	Li Jing
	Qi Zhan
	He Ming
	Qiao Xueying

Key words： Esophageal neoplasms/surgery Esophageal neoplasms/radiotherapy Esophageal neoplasms/chemotherapy Prognosis

Received: 14 April 2016

Corresponding Authors: Wang Yuxiang,Email:wyxhbs69@163.com.

Cite this article:

Wang Yuxiang,Yang Qiong,Qiu Rong et al. Value of postoperative adjuvant threapy for patients of stage Ⅲ thoracic esophageal squamous cell carcinoma after radical resection[J]. Chinese Journal of Radiation Oncology, 2017, 26(1): 22-28.

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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.issn.1004-4221.2017.01.005 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2017/V26/I1/22

[1] 张合林,刘瑞林,石彦涛,等.胸段食管癌切除术患者的预后分析[J].中华肿瘤杂志,2009,31(7):51-545.DOI:10.3760/cma.j.issn.0253-3766.2009.07.015.
Zhang HL,Liu RL,Shi YT,et al. Analysis of the survival in Patients after surgical resection of thoracic esophageal cancer[J].Chin J Oncol,2009,31(7):51-545.DOI:10.3760/cma.j.issn.0253-3766.2009.07.015.
[2] 张冬坤,苏晓冬,龙浩,等.胸段食管鳞状细胞癌外科治疗与预后分析[J].中华外科学杂志,2008,46(17):1333-1336.DOI:10.3321/j.issn.0529-5815.2008.17.014
Zhang DK,Su XD,Long H,et al. Surgical treatment and prognosis in patients with squamous cell carcinoma of thoracic esophagus[J].Chin J Surg,2008,46(17):1333-1336.DOI:10.3321/j.issn.0529-5815.2008.17.014
[3] 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.
[4] Xiao ZF,Yang ZY,Liang J,et alValue of radiotherapy after radical surgery for esophageal carcinoma:a report of 495 patients[J].Ann Thorac Surg,2003,75(2);331-336.
[5] Zhang W,Liu X,Xiao Z,et al. Postoperative intensity-modulated radiotherapy improved survival in lymph node-positive or stage Ⅲ thoracic esophageal squamous cell carcinoma[J].Oncol Res Treat,2015,38(3):97-102.DOI:10.1159/000375391.
[6] Yu Y,Wang Z,Yang Z,et al. Therapeutic efficacy evaluation of postoperative adjuvant radiotherapy in mid-thoracic esophageal carcinoma patients underwent Ivor Lewis esophagectomy with two-field lymphadenectomy[J].Med Oncol,2015,32(2):348.DOI:10.1007/s12032-014-0348-2.
[7] Jabbour SK,Thomas CR Jr. Radiation therapy in the postoperative　management of esophageal cancer[J].J Gastrointest Oncol,2010,1(2):102-111.DOI:10.3978/j.issn.2078-6891.2010.013.
[8] Chen J,Pan J,Zheng X,et al. Number and location of positive nodes,postoperative radiotherapy,and survival after esophagectomy with three-field lymph node dissection for thoracic esophageal squamous cellcarcinoma[J].Int J Radiat Oncol Biol Phys,2012,82(1):475-482.DOI:10.1016/j.ijrobp.2010.08.037.
[9] Chen SB,Weng HR,Wang G,et al. The impact of adjuvant radiotherapy on radically resected T₃ esophageal squamous cell carcinoma[J].J Cancer Res Clin Oncol,2016,142(1):277-286.DOI:10.1007/s00432-015-2041-z.
[10] Xu Y,Liu J,Du X,et al. Prognostic impact of postoperative radiation in patients undergoing radical esophagectomy for pathologic lymph node positive esophageal cancer[J].Radiat Oncol,2013,8:116.DOI:10.1186/1748-717X-8-116.
[11] Lyu X,Huang J,Mao Y,et al. Adjuvant chemotherapy after esophagectomy:is there a role in the treatment of the lymph node positive thoracic esophageal squamous cell carcinoma?[J].J Surg Oncol,2014,110(7):864-868.DOI:10.1002/jso.23716.
[12] Pasquer A,Gronnier C,Renaud F,et al. Impact of adjuvant chemotherapy on patients with lymph node-positive esophageal cancer who are primarily treated with surgery[J].Ann Surg Oncol,2015,22 Suppl 3:1340-1349.DOI:10.1245/s10434-015-4658-1.
[13] Chen H,Wu Z,Chen J,et al. Postoperative adjuvant therapy for resectable thoracic esophageal squamous cell carcinoma:a retrospective analysis of 426 cases[J].Med Oncol,2015,32(1):417.DOI:10.1007/s12032-014-0417-6.
[14] Ding X,Zhang J,Li B,et al. A meta-analysis of lymph node metastasis rate for patients with thoracic oesophageal cancer and its implication in delineation of clinical target volume for radiation therapy[J].Br J Radiol,2012,85(1019):e1110-1119.DOI:10.1259/bjr/12500248.
[15] Ando N,Iizuka T,Kakegawa T,et al. A randomized trial of surgery with and without chemotherapy for localized squamous carcinoma of the thoracic esophagus:the Japan Clinical Oncology Group Study[J].J Thorac Cardiovasc Surg,1997,114(2):205-209.
[16] Ando N,Iizuka T,Ide H,et al. Japan Clinical Oncology Group. Surgery plus chemotherapy compared with surgery alone for localized squamous cell carcinoma of the thoracic esophagus:a Japan Clinical Oncology Group Study—JCOG9204[J].J Clin Oncol,2003,21(24):4592-4596.
[17] Lee J,Lee KE,Im YH,et alAdjuvant chemotherapy with 5-fluorouracil and cisplatin in lymph node-positive thoracic esophageal squamous cell carcinoma[J].Ann Thorac Surg,2005,80(4):1170-1175.
[18] Heroor A,Fujita H,Sueyoshi S,et al. Adjuvant chemotherapy after radical resection of squamous cell carcinoma in the thoracic esophagus:Who benefits？ A retrospective study[J].Dig Surg,2003,20(3):229-35;discussion 236-237.
[19] Qin RQ,Wen YS,Wang WP,et al. The role of postoperative adjuvant chemotherapy for lymph node-positive esophageal squamous cell carcinoma:a propensity score matching analysis[J].Med Oncol,2016,33(4):31.DOI:10.1007/s12032-016-0746-8.
[20] Zhang J,Zhang YW,Chen ZW,et al. Adjuvant chemotherapy of cisplatin,5-fluorouracil and leucovorin for complete resectable esophageal cancer:a case-matched cohort study in east China[J].Dis Esophagus,2008,21(3):207-213.DOI:10.1111/j.1442-2050.2007.00748.x.
[21] Zhang SS,Yang H,Xie X,et al. Adjuvant chemotherapy versus surgery alone for esophageal squamous cell carcinoma:Meta-analysis ofrandomized controlled trials and nonrandomized studies[J].Dis Esophagus,2014,27(6):574-584.DOI:10.1111/dote.12073.
[22] Duan J,Deng T,Ying G,et al. Prognostic nomogram for previously untreated patients with esophageal squamous cell carcinoma after esophagectomy followed by adjuvant chemotherapy[J].Jpn J Clin Oncol,2016,46(4):336-343.DOI:10.1093/jjco/hyv206.