Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankan Road, Chang'an District, Shijiazhaung, 050011, China.
Department of Radiation, The First Hospital of Shijiazhaung, Shijiazhaung, 050011, China.
World J Surg Oncol. 2017 Oct 25;15(1):192. doi: 10.1186/s12957-017-1259-4.
Five-year overall survival rate of TESCC after surgery is low (approximately 30% to 60%), so it is meaningful to discuss the significance of PORT.
We retrospectively collected the data of 227 patients with TNM esophageal cancer (EC). The failure pattern after surgery was analyzed. Difference of adjuvant PORT in patients with TNM TESCC and the appropriate population were explored based on the relevant studies.
There were 58 cases with intrathoracic locoregional recurrence (LRR) after radical surgery and 27 cases with distant metastasis, including 10 cases of recurrence. The recurrence rate of mediastinal lymph nodes in the thoracic cavity was 50.0%. Univariate analysis revealed that compared with patients with middle and lower thoracic EC, the 3/5-year survival rate of patients with upper thoracic EC was significantly lower, accompanied with remarkably higher thoracic LRR. Compared with those with moderately- and well-differentiated TESCC, the 3/5-year survival rate of patients with poorly differentiated TESCC was significantly lower, whereas the distant metastasis rate was notably higher. Multivariate analysis revealed that different lesion locations and different pathologic differentiation were the independent prognostic factors. The lesion location and degree of differentiation were the independent influencing factors for thoracic LRR and distant metastasis, respectively.
The intrathoracic LRR is the major failure pattern for patients with TNM TESCC after conventional two-field lymphadenectomy. In addition, recurrence rate of TNM TESCC was significantly higher in upper thoracic EC than in middle and lower thoracic EC. PORT is recommended to patients with TNM upper TESCC.
手术后 TESCC 的五年总生存率较低（约 30%至 60%），因此探讨 PORT 的意义具有重要意义。
我们回顾性收集了 227 例 TNM 食管癌患者的数据。分析了手术后的失败模式。根据相关研究，探讨了 TNM TESCC 患者辅助 PORT 的差异和适宜人群。
根治性手术后有 58 例出现胸内局部区域复发（LRR），27 例发生远处转移，包括 10 例复发。胸腔纵隔淋巴结的复发率为 50.0%。单因素分析显示，与中下段食管癌患者相比，中上段食管癌患者的 3/5 年生存率明显较低，伴有更高的胸内 LRR。与中-高分化 TESCC 相比，低分化 TESCC 患者的 3/5 年生存率明显较低，而远处转移率明显较高。多因素分析显示，不同病变部位和不同病理分化是独立的预后因素。病变部位和分化程度是胸内 LRR 和远处转移的独立影响因素。
常规二野淋巴结清扫术后，TNM TESCC 患者的主要失败模式为胸内 LRR。此外，TNM 中上段食管癌患者的复发率明显高于中下段食管癌。建议对 TNM 上段 TESCC 患者进行 PORT。
