[影响Ⅲ期胸段食管癌患者食管癌切除术后长期生存的因素]

[Factors affecting on long-time survival in patients with stage Ⅲ thoracic esophageal carcinoma after esophagectomy].

作者信息

Yang Q, Wang Y X, He M, Li J, Qi Z, Zhu S C, Qiao X Y

机构信息

Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China(Present Unit: Department of Radiation Oncology, Handan Central Hospital, Handan, Hebei Province 056001, China).

Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China.

出版信息

Zhonghua Zhong Liu Za Zhi. 2016 Jul;38(7):530-7. doi: 10.3760/cma.j.issn.0253-3766.2016.07.010.

DOI:10.3760/cma.j.issn.0253-3766.2016.07.010

PMID:27531268

Abstract

OBJECTIVE

To retrospectively analyze the prognosis and its related factor in stage Ⅲ thoracic esophageal carcinoma after surgery.

METHODS

504 patients with stage Ⅲ thoracic esophageal cancer after resection were included in this study. There were 388 males and 116 females. The median age was 60 years. 476 cases were treated with two-field and 28 with three-field lymphadenectomy. There were 44 cases of upper-, 334 of middle-, and 126 of lower-thoracic esophageal cancer. There were 292 patients with stage Ⅲa, 128 with stage Ⅲb and 84 with stage Ⅲc esophageal cancer. 137 patients were treated with surgery alone, 264 had postoperative chemotherapy (CT), 64 had radiotherapy (RT) and 39 had CT plus RT.

RESULTS

The follow-up was ended on September 31, 2014. The 1-, 3-, and 5-year overall survival (OS) rates and median survival were 73.0%, 34.4%, 26.7% and 22 months, respectively. Univariate analysis showed that mode of surgery, site of lesion, N and TNM stages, and postoperative adjuvant therapy were significantly associated with OS (P<0.05 for all). Multivariate analysis showed that TNM and adjuvant therapy were independent factors for OS (P<0.05 for both). The 1-, 3-, 5-years progression-free survival (PFS) rates of patients undergoing postoperative adjuvant therapy were 57.3%, 32.0% and 27.0%, respectively, higher than those of the patients treated by surgery alone (P<0.05). Further analysis showed that postoperative chemotherapy and/or radiotherapy could mainly improve OS in the patients with cancer in the upper- or middle-thoracic segment and well- or moderately differentiated squamous cell carcimoma (P<0.05). Univariate analysis showed that site of lesion, N and TNM stage, R0/R1 and adjuvant therapy were significantly related to PFS (P<0.05). Multivariate analysis showed that site of lesion, R0/R1 resection, TNM stage and postoperative adjuvant therapy were independent factors for PFS (P<0.05 for all). Patients with severe adhesion at surgery or R1 resection had a lower PFS rate (P<0.05).

CONCLUSIONS

The prognosis of stage Ⅲ esophageal carcinoma after two-field surgery is poor. TNM stage and postoperative adjuvant therapy are independent factors for OS and PFS. Postoperative chemotherapy and/or radiotherapy can improve OS and PFS. Site of lesion is also associated with prognosis. The risk of disease progression could be increased in patients with severe adhesion at surgery or R1 resection.

摘要

目的

回顾性分析Ⅲ期胸段食管癌术后的预后及其相关因素。

方法

本研究纳入504例Ⅲ期胸段食管癌切除术后患者。其中男性388例，女性116例。中位年龄为60岁。476例行两野淋巴结清扫术，28例行三野淋巴结清扫术。胸段食管癌上段44例，中段334例，下段126例。Ⅲa期食管癌292例，Ⅲb期128例，Ⅲc期84例。137例仅接受手术治疗，264例接受术后化疗（CT），64例接受放疗（RT），39例接受CT联合RT。

结果

随访至2014年9月31日结束。1年、3年和5年总生存率（OS）及中位生存期分别为73.0%、34.4%、26.7%和22个月。单因素分析显示，手术方式、病变部位、N和TNM分期以及术后辅助治疗与OS显著相关（均P<0.05）。多因素分析显示，TNM分期和辅助治疗是OS的独立因素（均P<0.05）。接受术后辅助治疗患者的1年、3年、5年无进展生存率（PFS）分别为57.3%、32.0%和27.0%，高于单纯手术治疗患者（P<0.05）。进一步分析显示，术后化疗和/或放疗主要可改善胸段上段或中段癌以及高分化或中分化鳞状细胞癌患者的OS（P<0.05）。单因素分析显示，病变部位、N和TNM分期、R0/R1及辅助治疗与PFS显著相关（P<0.05）。多因素分析显示，病变部位、R0/R1切除、TNM分期及术后辅助治疗是PFS的独立因素（均P<0.05）。手术时粘连严重或R1切除的患者PFS率较低（P<0.05）。