Department of Oncology, Division of Radiation Oncology, London Health Sciences Center, University of Western Ontario, London, ON.
Curr Oncol. 2010 Nov;17(6):46-51. doi: 10.3747/co.v17i6.561.
The present study investigated factors affecting outcome at relapse after previous surgery and adjuvant chemoradiation (crt) in high-risk esophageal cancer patients.
From 1989 to 1999, we followed high-risk resected esophageal cancer patients who had completed postoperative crt therapy. Patients who relapsed with a disease-free interval of less than 3 months were treated with palliative crt when appropriate. Patients with a disease-free interval of 3 months or more were treated with best supportive care. Post-recurrence survival was estimated using the Kaplan-Meier technique, and statistical comparisons were made using log-rank chi-square tests and Cox regression.
Of the 69 patients treated with adjuvant crt after esophagectomy, 46 experienced recurrence. Median time to relapse was 28 months (range: 0.1-40 months). Among the 46 relapsed patients, median age was 61 years (range: 37-82 years), and 42 were men. At the initial staging, 44 of 46 were node-positive; 31 of 46 had adenocarcinoma. In 33 of 46, post-esophagectomy resection margins were clear. Median follow-up after recurrence was 30.5 months (range: 1.3-100 months). Median overall survival after recurrence was 5.8 months, and the 12-month, 24-month, and 36-month survival rates were 20%, 10%, and 5% respectively. Of the prognostic factors analyzed, only resection margin status and interval to recurrence were statistically significant for patient outcome in univariate and multivariate analysis. Patients who had positive resection margins and who relapsed 12 or fewer months after surgery and adjuvant crt had a median post-recurrence overall survival of 0.85 months as compared with 6.0 months in other patients (more than 12 months to relapse, or negative resection margins, or both; log-rank p = 0.003).
Resection margin status and interval to disease relapse are significant independent prognostic factors for patient outcome after adjuvant crt therapy.
本研究旨在探讨影响既往手术及辅助放化疗（CRT）后高危食管癌患者复发结局的因素。
1989 年至 1999 年，我们随访了完成术后 CRT 治疗的高危食管癌切除患者。无疾病间隔小于 3 个月复发的患者在适当情况下接受姑息性 CRT 治疗。无疾病间隔 3 个月或更长时间的患者接受最佳支持治疗。采用 Kaplan-Meier 技术估计复发后生存情况，并采用对数秩 χ2 检验和 Cox 回归进行统计比较。
在 69 例接受辅助 CRT 治疗的食管癌患者中，46 例出现复发。中位复发时间为 28 个月（范围：0.1-40 个月）。在 46 例复发患者中，中位年龄为 61 岁（范围：37-82 岁），42 例为男性。在初始分期时，44 例为淋巴结阳性；46 例中有 31 例为腺癌。在 33 例中，术后食管切除术切缘为阴性。复发后中位随访时间为 30.5 个月（范围：1.3-100 个月）。复发后总生存期的中位数为 5.8 个月，12 个月、24 个月和 36 个月的生存率分别为 20%、10%和 5%。在分析的预后因素中，仅切除边缘状态和复发间隔在单因素和多因素分析中对患者结局有统计学意义。切缘阳性且在术后和辅助 CRT 后 12 个月或更短时间内复发的患者，复发后总生存的中位时间为 0.85 个月，而其他患者（复发时间超过 12 个月，或切缘阴性，或两者兼有）的中位时间为 6.0 个月（对数秩 p=0.003）。
切除边缘状态和疾病复发间隔是辅助 CRT 治疗后患者结局的重要独立预后因素。
