Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linko, Taoyuan, Taiwan.
Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linko, Taoyuan, Taiwan; Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan.
J Thorac Cardiovasc Surg. 2018 May;155(5):2233-2242.e2. doi: 10.1016/j.jtcvs.2017.12.082. Epub 2017 Dec 26.
Definitive chemoradiotherapy (dCRT) represents a curative nonsurgical treatment option for patients with esophageal cancer. However, tumor recurrence is common after dCRT, even when clinical complete response (cCR) is achieved. Here, we investigated the timing, patterns, and risk factors for recurrence in patients with esophageal squamous cell carcinoma (ESCC) who achieved cCR following dCRT.
We retrospectively examined the clinical records of patients with ESCC who achieved cCR following dCRT between 2001 and 2014. Locoregional recurrence (LR) was defined as a recurrence occurring in the esophageal lumen and/or locoregional lymph nodes. Recurrences at any other sites were considered as distant recurrences (DRs).
A total of 102 patients who achieved cCR were included. After a mean follow-up of 54.5 months, 51 patients developed recurrences (34 LRs, 6 combined LR and DR, and 11 DRs). The cumulative 1-, 3-, and 5-year recurrence rates were 35%, 46%, and 50%, respectively. The mean time to recurrence for the 40 patients with LRs (including LRs plus LRs/DRs) was significantly shorter (281.4 days) compared with that of patients with DRs (643.6 days; P = .006), with 95% of the former being diagnosed within 2 years. Multivariate Cox regression analysis identified pretreatment clinical stage III as the only independent risk factor for LR (hazard ratio, 2.732; 95% confidence interval; 1.063-7.020; P = .037).
Disease recurrence occurs in 50% of ESCC patients who achieve cCR following dCRT, with LR being the most common pattern. Advanced pretreatment clinical stage is an independent risk factor for LR.
根治性放化疗（dCRT）是治疗食管癌患者的一种有治愈可能的非手术治疗选择。然而，即使达到临床完全缓解（cCR），肿瘤仍常复发。在此，我们研究了接受 dCRT 后达到 cCR 的食管鳞状细胞癌（ESCC）患者的复发时间、模式和危险因素。
我们回顾性地检查了 2001 年至 2014 年间接受 dCRT 后达到 cCR 的 ESCC 患者的临床记录。局部区域复发（LR）定义为发生在食管腔和/或局部区域淋巴结的复发。其他任何部位的复发均被认为是远处复发（DR）。
共纳入 102 例达到 cCR 的患者。平均随访 54.5 个月后，51 例患者出现复发（34 例 LR，6 例 LR/DR 联合，11 例 DR）。1、3 和 5 年的累积复发率分别为 35%、46%和 50%。40 例 LR 患者（包括 LR 和 LR/DRs）的复发时间明显短于 11 例 DR 患者（281.4 天比 643.6 天；P=0.006），前者 95%在 2 年内确诊。多因素 Cox 回归分析显示，治疗前临床分期 III 期是 LR 的唯一独立危险因素（风险比，2.732；95%置信区间；1.063-7.020；P=0.037）。
接受 dCRT 后达到 cCR 的 ESCC 患者中有 50%会出现疾病复发，LR 是最常见的复发模式。治疗前临床分期较晚是 LR 的独立危险因素。
