Hsu Po-Kuei, Chien Ling-I, Wang Lei-Chi, Chou Teh-Ying
Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Eur J Cardiothorac Surg. 2017 Jun 1;51(6):1188-1194. doi: 10.1093/ejcts/ezx029.
Patients with oesophageal squamous cell carcinoma have a high risk of disease recurrence even after trimodality treatments, which include preoperative chemoradiotherapy and oesophagectomy. We aimed to identify the histological factors that are associated with loco-regional and distant recurrence.
A retrospective review of a prospectively established database identified patients who received preoperative chemoradiotherapy and oesophagectomy for squamous cell carcinoma. The impact of histological factors, including surgical resection margins, lymphovascular invasion (LVI), perineural invasion (PNI), extracapsular invasion (ECI) and tumour regression grade (TRG), on disease recurrence was analysed.
A total of 116 patients treated between 2009 and 2015 were included. Sixty-one patients developed disease recurrence, including 25 loco-regional and 49 distant recurrences, with a median disease-free interval of 6 months. Positive histological surgical resection margins were significantly associated with loco-regional recurrence, whereas pre-treatment N stage, ypT stage, ypN stage, positive surgical resection margins, TRG, LVI, PNI, ECI and TRG were significant prognostic factors for distant recurrence. Upon multivariate analysis, cN stage [hazard ratio (HR): 4.049; 95% confidence interval (CI): 1.242-13.200, P = 0.020], LVI (HR: 3.658; 95% CI: 1.891-7.078, P < 0.001) and ECI (HR: 2.393; 95% CI: 1.202-4.763, P = 0.013) remained independent factors for distant recurrence. The 1- and 3-year freedom from distant recurrence rates were 71.8 and 65.6%, respectively, when both LVI and ECI factors were absent, compared to 17.6 and 14.1% when either or both were present ( P < 0.001).
Patients with lymphovascular invasion and extracapsular invasion are at a high risk of distant recurrence after preoperative chemoradiotherapy and oesophagectomy. Effective systemic therapy and intensive surveillance are necessary in this group of patients.
即使接受了包括术前放化疗和食管切除术在内的三联疗法，食管鳞状细胞癌患者仍有较高的疾病复发风险。我们旨在确定与局部区域和远处复发相关的组织学因素。
对一个前瞻性建立的数据库进行回顾性分析，确定接受术前放化疗和食管鳞状细胞癌切除术的患者。分析了包括手术切缘、脉管侵犯（LVI）、神经侵犯（PNI）、包膜外侵犯（ECI）和肿瘤退缩分级（TRG）在内的组织学因素对疾病复发的影响。
纳入了2009年至2015年间接受治疗的116例患者。61例患者出现疾病复发，包括25例局部区域复发和49例远处复发，无病间期中位数为6个月。手术切缘阳性与局部区域复发显著相关，而治疗前N分期、ypT分期、ypN分期、手术切缘阳性、TRG、LVI、PNI、ECI和TRG是远处复发的重要预后因素。多因素分析显示，cN分期[风险比（HR）：4.049；95%置信区间（CI）：1.242 - 13.200，P = 0.020]、LVI（HR：3.658；95%CI：1.891 - 7.078，P < 0.001）和ECI（HR：2.393；95%CI：1.202 - 4.763，P = 0.013）仍然是远处复发的独立因素。当LVI和ECI因素均不存在时，1年和3年远处无复发生存率分别为71.8%和65.6%，而当存在其中任何一个或两个因素时，分别为17.6%和14.1%（P < 0.001）。
脉管侵犯和包膜外侵犯的患者在术前放化疗和食管切除术后有较高的远处复发风险。对这组患者进行有效的全身治疗和密切监测是必要的。
