新辅助放化疗及食管切除术后的病理分期能较好地预测食管鳞状细胞癌患者的生存率。

Pathological stage after neoadjuvant chemoradiation and esophagectomy superiorly predicts survival in patients with esophageal squamous cell carcinoma.

作者信息

Wang Chia-Chun, Cheng Jason Chia-Hsien, Tsai Chiao-Ling, Lee Jang-Ming, Huang Pei-Ming, Lin Chia-Chi, Hsu Chih-Hung, Hsieh Min-Shu, Chang Yih-Leong, Hsu Feng-Ming

机构信息

Department of Oncology, National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.

Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.

出版信息

Radiother Oncol. 2015 Apr;115(1):9-15. doi: 10.1016/j.radonc.2015.03.019. Epub 2015 Mar 26.

DOI:10.1016/j.radonc.2015.03.019

PMID:25819996

Abstract

BACKGROUND AND PURPOSE

To assess the usefulness of pathological stage according to the 7th edition of the Union for International Cancer Control-American Joint Committee on Cancer (UICC-AJCC) as a prognostic tool in patients undergoing neoadjuvant chemoradiation followed by esophagectomy (trimodality therapy, TMT) for locally advanced esophageal squamous cell carcinoma.

MATERIAL AND METHODS

One hundred twenty-five eligible patients completing TMT were enrolled for analysis. The clinical (cTNM7) and pathological (ypTNM7) stage groups of their tumors were prospectively classified, and re-grouped by the 6th edition (ypTNM6). Survival was analyzed using the Kaplan-Meier method. The Cox proportional hazard model and the Akaike information criterion (AIC) were used to compare the performance of staging systems.

RESULTS

With a median follow-up of 24.6 months, 54 patients (43.2%) died. Forty patients (32%) achieved pathological complete remission (pCR). The median survival was 31.8 months. On multivariate analysis, ypTNM7 (but not pCR or pN) was the only independent factor affecting overall survival (p<0.001). The ypTNM7 was superior to cTNM7 or ypTNM6 in predicting both overall and recurrence-free survival after TMT based on AIC values and Cox proportional hazard model analysis.

CONCLUSIONS

In patients with locally advanced esophageal squamous cell carcinoma undergoing TMT, ypTNM7 is the best predictor of survival.

摘要

背景与目的

评估依据国际抗癌联盟-美国癌症联合委员会（UICC-AJCC）第7版的病理分期，作为接受新辅助放化疗后行食管切除术（三联疗法，TMT）的局部晚期食管鳞状细胞癌患者的预后工具的实用性。

材料与方法

125例完成TMT的符合条件患者纳入分析。前瞻性地对其肿瘤的临床（cTNM7）和病理（ypTNM7）分期组进行分类，并按照第6版（ypTNM6）重新分组。采用Kaplan-Meier法分析生存情况。使用Cox比例风险模型和赤池信息准则（AIC）比较分期系统的性能。

结果

中位随访24.6个月，54例患者（43.2%）死亡。40例患者（32%）达到病理完全缓解（pCR）。中位生存期为31.8个月。多因素分析显示，ypTNM7（而非pCR或pN）是影响总生存的唯一独立因素（p<0.001）。基于AIC值和Cox比例风险模型分析，ypTNM7在预测TMT后的总生存和无复发生存方面优于cTNM7或ypTNM6。