Ⅱ、Ⅲ期胸段食管鳞癌术后不同辅助治疗方式的疗效分析

doi:10.3760/cma.j.issn.1004-4221.2017.03.007

Abstract
Figure/Table
References()
Related Citation (15)
Read Tracking
Download Tracking

Download: PDF (891 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS) Supporting Info

Abstract Objective To evaluate the efficacy and adverse reactions of postoperative chemoradiotherapy (S+CRT) and postoperative radiotherapy (S+RT) for stage Ⅱ/Ⅲ thoracic esophageal squamous cell carcinoma. Methods Clinical data were collected from 215 patients with stage Ⅱ/Ⅲ thoracic esophageal squamous cell carcinoma who received radical resection and postoperative adjuvant radiotherapy or chemoradiotherapy from 2007 to 2010. Survival rates were calculated by the Kaplan-Meier method and analyzed by the log-rank test. Univariate and multivariate analyses were made by the log-rank test and Cox proportional model, respectively. Results The data were comparable between the S+CRT group and the S+RT group (P=0.055-0.988). The numbers of patients who received 1-, 3-, and 5-year follow-up were 203, 133, and 108, respectively. In all the patients, the 1-, 3-, and 5-year overall survival (OS) rates were 94.0%, 61.4%, and 49.3%, respectively, and the 1-, 3-, and 5-year disease-free survival (DFS) rates were 74.9%, 53.5%, 46.7%, respectively. Preoperative mediastinal lymph node enlargement on computed tomography (CT), the degree of adhesion of esophageal lesions to peripheral tissues during surgery, pathological N staging, vascular tumor thrombus, the number of positive lymph nodes, and treatment strategy were independent prognostic factors for OS (P=0.000-0.034). Preoperative mediastinal lymph node enlargement revealed on CT, the degree of adhesion of esophageal lesions to peripheral tissues during surgery, incomplete removal of tumor from the esophagus, the number of positive lymph nodes, and treatment strategy were independent prognostic factors for DFS (P=0.000-0.049). The S+CRT group had significantly improved OS and DFS rates than the S+RT group (P=0.002, 0.002). The result of stratified analysis showed that for the patients with stage Ⅱ disease and those with stage N₁ disease, the S+CRT group had significantly improved OS and DFS rates than the S+RT group (P=0.041, 0.001, 0.021, 0.024). The S+CRT group had significantly higher incidence rates of grade ≥2 radiation-induced gastritis and marrow suppression than the S+RT group (P=0.000, 0.015). Conclusions Both S+CRT and S+RT achieve satisfactory treatment outcomes in patients with stage Ⅱ/Ⅲ thoracic esophageal squamous cell carcinoma. Compared with S+RT, S+CRT can significantly improve the OS and DFS in patients with stage Ⅱ or N₁ disease;S+CRT causes more severe but tolerable adverse reactions. Prospective randomized phase Ⅲ clinical studies are still required to confirm the final conclusions.

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	Shen Wenbin
	Gao Hongmei
	Zhu Shuchai
	Li Teng
	Li Shuguang
	Li Youmei
	Liu Zhikun
	Li Juan
	Su Jingwei

Key words： Esophageal neoplasms/surgery Esophageal neoplasms/postoperative radiotherapy
Esophageal neoplasms/postoperative chemoradiotherapy Prognosis

Received: 12 April 2016

Corresponding Authors: Zhu Shuchai,Email:sczhu1965@126.com

Cite this article:

Shen Wenbin,Gao Hongmei,Zhu Shuchai et al. Efficacy of different postoperative adjuvant therapy strategies for stage Ⅱ/Ⅲ thoracic esophageal squamous cell carcinoma[J]. Chinese Journal of Radiation Oncology, 2017, 26(3): 279-286.

URL:

http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.issn.1004-4221.2017.03.007 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2017/V26/I3/279

[1] 肖泽芬,杨宗贻,梁军,等.食管癌根治术后预防性放射治疗的临床价值[J].中华肿瘤杂志,2002,24(6):608-611.DOI:10.3760/j.issn:0253-3766.2002.06.028.
Xiao ZF,Yang ZY,Liang J,et al. Clinical value of prophylactic radiotherapy after curative resection of esophageal carcinoma[J].Chin J Oncol,2002,24(6):608-611.DOI:10.3760/j.issn:0253-3766.2002.06.028.
[2] 肖泽芬,杨宗贻,王绿化,等.食管癌术后淋巴结转移对生存率的影响和放射治疗的意义[J].中华肿瘤杂志,2004,26(2):112-115.DOI:10.3760/j.issn:0253-3766.2004.02.016.
Xiao ZF,Yang ZY,Wang LH,et al. Influence of the number of lymph node metastasis on survival and significance of postoperative radiotherapy for esophageal carcinoma[J].Chin J Oncol,2004,26(2):112-115.DOI:10.3760/j.issn:0253-3766.2004.02.016.
[3] 陈俊强,潘建基,陈明强,等.胸段食管鳞癌淋巴结转移数和区域与术后放疗价值的临床研究[J].中华放射肿瘤学杂志,2010,19(2):105-109.DOI:10.3760/cma.j.issn.1004-4221.2010.02.005.
Chen JQ,Pan JJ,Chen MQ,et al. Value of the number and distribution of metastatic lymph nodes in postoperative radiotherapy for thoracic esophageal squamous cell carcinoma[J].Chin J Radiat Oncol,2010,19(2):105-109.DOI:10.3760/cma.j.issn.1004-4221.2010.02.005.
[4] 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.
[5] 杨劲松,刘晓,肖泽芬,等.pT_2-3N₀M₀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 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.
[6] 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
[7] 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.
[8] 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. French University Association for surgical Research[J].Surg Gynecol Obstet,1991,173(2):123-130.
[9] 朱海文,陈国雄,王迎选,等.食管癌术后放射治疗[J].中华放射肿瘤学杂志,1998,7(1):46-48.
Zhu HW,Chen GX,Wang YX,et al. Postoperative radiotherapy for esophageal carcinoma[J].Chin J Radiat Oncol,1998,7(1):46-48.
[10] 刘明,李任,王敬一,等.食管癌根治术后预防性照射的研究[J].中华放射肿瘤学杂志,1994,3(4):268.
Liu M,Li R,Wang JY,et al. Study on prophylactic irradiation after radical operation of esophageal cancer[J].Chin J Radit Oncol,1994,3(4):268.
[11] 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.
[12] 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,L 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.
[13] 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.DOI:10.3760/cma.j.issn.0366-6999.20121798
[14] 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.
[15] 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.
[16] Bédard EL,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.
[17] Visbal AL,Allen MS,Miller DL,et al. IvorLewis esophagogastrectomy for esophageal cancer[J].Ann Thorac Surg,2001,71(6):1803-1808.DOI:10.1016/S0003-4975(01)02601-7.
[18] Baba M,Aikou T,Yoshinaka H,et al. Long-term results of subtotal esophagectomy with three-field lymphadenectomy for carcinoma of the thoracic esophagus[J].Ann Surg,1994,219(3):310-316.DOI:10.1097/00000658-199403000-00012
[19] Xu YP,Liu JS,Du XH,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.
[20] 陈俊强,潘建基,李建成,等.淋巴结阳性胸段食管鳞癌术后放化疗临床研究[J].中华放射肿瘤学杂志,2011,20(4):287-290.DOI:10.3760/cma.j.issn.1004-4221.2011.04.008.
Chen JQ,Pan JJ,Li JC,et al. Clinical study of postoperative chemoradiotherapy of thoracic esophageal squamous cell carcinoma with positive lymph nodes[J].Chin J Radiat Oncol,2011,20(4):287-290.DOI:10.3760/cma.j.issn.1004-4221.2011.04.008.
[21] Wang ZW,Luan ZP,Zhang W,et al. Postoperative chemoradiotherapy improves survival in esophageal squamous cell cancer with extracapsular lymph node extension[J].Neoplasma,2014,61(6):732-738.DOI:10.4149/neo_2014_089.
[22] 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.
[22] Waraich N,Rashid F,Jan A,et al. Vascular invasion is not a risk factor in Oesophageal Cancer recurrence[J].Int J Surg,2011,9(3):237-240.DOI:10.1016/j.ijsu.2010.12.002.
[23] Khan OA,Alexiou C,Soomro I,et al. Pathological determinants of survival in node-negative oesophageal cancer[J].Br J Surg,2004,91(12):1586-1591.DOI:10.1002/bjs.4778.
[24] Kunisaki C,Makino H,Oshima T,et al. Clinicopathological features in N₀ oesophageal cancer patients[J].Anticancer Res,2010,30(7):3063-3069.
[25] 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.
[26] Werner-Wasik M,Pequignot E,Leeper D,et al. Predictors of severe esophagitis include use of concurrent chemotherapy,but not the length of irradiated esophagus:a multivariate analysis of patients with lung cancer treated with nonoperative therapy[J].Int J Radiat Oncol Biol Phys,2000,48(3):689-696.DOI:10.1016/S0360-3016(00)00699-4.
[27] Hirota S,Tsujino K,Hishikawa Y,et al. Endoscopic findings of radiation esophagitis in concurrent chemoradiotherapy for intrathoracic malignancies[J].Radiother Oncol,2001,58(3):273-278.DOI:10.1016/S0167-8140(00)00274-7.
[28] Wu S,Deng X,Zhang P,et al. Phase Ⅱ study of postoperative chemoradiotherapy for esophageal carcinoma[J].J Clin Oncol,2009,27(15S):e15606.DOI:10.1200/jco.2009.27.15 s.e15606.
[29] Zieren HU,Müller JM,Jacobi CA,et al. Adjuvant postoperative radiation therapy after curative resection of squamous cell carcinoma of the thoracic esophagus:a prospective randomized study[J].World J Surg,1995,19(3):444-449.DOI:10.1007/BF00299187.
[30] Fok M,Sham JS,Choy D,et al. Postoperative radiotherapy for carcinoma of the esophagus:a prospective,randomized controlled study[J].Surgery,1993,113(2):138-147.