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食管癌根治术后淋巴结复发的挽救性放化疗

Salvage radiochemotherapy for lymph node recurrence after radical surgery of esophageal cancer.

作者信息

Zhou Yi-Qin, Ding Nai-Xin, Wang Li-Jun, Liu Wei, Jiang Ming, Lu Jin-Cheng

机构信息

Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Xuanwu District, Nanjing, Jiangsu Province, P.R. China.

出版信息

Medicine (Baltimore). 2018 Feb;97(5):e9777. doi: 10.1097/MD.0000000000009777.

Abstract

To evaluate the efficacy of salvage radiochemotherapy (SRC) in patients with recurrent lymph node after radical surgery in esophageal cancer.This study enrolled 58 patients with esophageal squamous cell carcinoma who underwent SRC for lymph node recurrence after radical surgery from August 2011 to November 2015 at our hospital. Survival rates were calculated by the Kaplan-Meier method with the log-rank test. Multivariate analysis was conducted using the Cox model.The overall 1-, 3-, and 5-year survival rates after radical surgery were 94.8%, 53.0%, and 29.6%, respectively. The 1- and 3-year survival rates after SRC were 68.7% and 26.9%, respectively. The major acute toxicities were esophagitis and neutropenia, while most toxicities were grade 1 or 2. There was no unexpected increase in serious adverse events or treatment-related deaths. The results of multivariate analysis showed that time to recurrence (odds ratio [OR]: 0.25, 95% confidence interval [CI]: 0.11-0.53, P = .0004), T stage (OR: 2.75, 95%CI: 1.16-6.49, P = .021), and prophylactic radiotherapy/chemotherapy (PRC, OR: 0.39, 95%CI: 0.16-0.98, P = .045) were determinants of postoperative overall survival, and PRC was the only factor affecting the outcome of SRC (OR: 0.28, 95%CI: 0.12-0.70, P = .006).SRC is an effective treatment for recurrent lymph node after radical surgery of esophageal cancer.

摘要

评估挽救性放化疗(SRC)对食管癌根治术后淋巴结复发患者的疗效。本研究纳入了2011年8月至2015年11月在我院因淋巴结复发接受SRC的58例食管鳞状细胞癌患者。采用Kaplan-Meier法计算生存率,并进行对数秩检验。使用Cox模型进行多因素分析。根治术后1年、3年和5年的总生存率分别为94.8%、53.0%和29.6%。SRC后1年和3年的生存率分别为68.7%和26.9%。主要的急性毒性反应为食管炎和中性粒细胞减少,而大多数毒性反应为1级或2级。严重不良事件或治疗相关死亡没有意外增加。多因素分析结果显示,复发时间(比值比[OR]:0.25,95%置信区间[CI]:0.11 - 0.53,P = 0.0004)、T分期(OR:2.75,95%CI:1.16 - 6.49,P = 0.021)和预防性放疗/化疗(PRC,OR:0.39,95%CI:0.16 - 0.98,P = 0.045)是术后总生存的决定因素,PRC是影响SRC结局的唯一因素(OR:0.28,95%CI:0.12 - 0.70,P = 0.006)。SRC是食管癌根治术后淋巴结复发的有效治疗方法。

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