新辅助放化疗后手术治疗的食管鳞状细胞癌预后因素评估
Evaluation of Prognostic Factors for Esophageal Squamous Cell Carcinoma Treated with Neoadjuvant Chemoradiotherapy Followed by Surgery.
作者信息
Hamai Yoichi, Hihara Jun, Emi Manabu, Furukawa Takaoki, Murakami Yuji, Nishibuchi Ikuno, Ibuki Yuta, Yamakita Ichiko, Kurokawa Tomoaki, Nagata Yasushi, Okada Morihito
机构信息
Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
Department of Radiation Oncology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
出版信息
World J Surg. 2018 May;42(5):1496-1505. doi: 10.1007/s00268-017-4283-1.
BACKGROUND
Intensive trimodality therapy is needed for locally advanced esophageal squamous cell carcinoma (ESCC). However, some patients develop recurrence and die of cancer even after trimodality therapy.
METHODS
We evaluated prognostic factors based on data from 125 patients with ESCC who underwent neoadjuvant chemoradiotherapy (NCRT) comprising concurrent chemotherapy and 40 Gy of radiation, followed by curative-intent esophagectomy.
RESULTS
Thirty-four (27.2%) patients achieved a pathological complete response (pCR) after NCRT. The 5-year recurrence-free (RFS) and overall survival (OS) rates of all patients were 49.2 and 52.9%, respectively, and were significantly better for patients with pCR than without pCR (p = 0.01 and 0.02, respectively). Univariate and multivariate analyses selected performance status [PS 0 vs. 1: hazard ratio (HR) 2.05; 95% confidence interval (CI) 1.30-4.84; p = 0.01] and ypN (0 vs. 1: HR 2.33; 95% CI 1.12-4.84; p = 0.02; 0 vs. 2/3: HR 3.73; 95% CI 1.68-8.28; p = 0.001) as independent covariates for RFS. Furthermore, PS (0 vs. 1; HR 2.94; 95% CI 1.51-5.72; p = 0.002) and ypN (0 vs. 1; HR 2.26; 95% CI 1.09-4.69; p = 0.03; 0 vs. 2/3: HR 3.90; 95% CI 1.79-8.48; p = 0.001) were also independent covariates for OS.
CONCLUSIONS
Performance status 1 and ypN+ were significantly associated with a poor prognosis after trimodality therapy for ESCC.
背景
局部晚期食管鳞状细胞癌（ESCC）需要强化三联疗法。然而，一些患者即使接受了三联疗法仍会出现复发并死于癌症。
方法
我们基于125例接受新辅助放化疗（NCRT）的ESCC患者的数据评估预后因素，NCRT包括同步化疗和40 Gy放疗，随后进行根治性食管切除术。
结果
34例（27.2%）患者在NCRT后达到病理完全缓解（pCR）。所有患者的5年无复发生存率（RFS）和总生存率（OS）分别为49.2%和52.9%，pCR患者的这两项生存率显著优于未达到pCR的患者（分别为p = 0.01和0.02）。单因素和多因素分析选择体能状态[PS 0 vs. 1：风险比（HR）2.05；95%置信区间（CI）1.30 - 4.84；p = 0.01]和ypN（0 vs. 1：HR 2.33；95% CI 1.12 - 4.84；p = 0.02；0 vs. 2/3：HR 3.73；95% CI 1.68 - 8.28；p = 0.001）作为RFS的独立协变量。此外，PS（0 vs. 1；HR 2.94；95% CI 1.51 - 5.72；p = 0.002）和ypN（0 vs. 1；HR 2.26；95% CI 1.09 - 4.69；p = 0.03；0 vs. 2/3：HR 3.90；95% CI 1.79 - 8.48；p = 0.001）也是OS的独立协变量。
结论
体能状态1和ypN+与ESCC三联疗法后的不良预后显著相关。
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