多模式局部治疗对食管癌切除术后胸段食管鳞状细胞癌复发的生存获益。

Survival benefit of multimodal local therapy for repeat recurrence of thoracic esophageal squamous cell carcinoma after esophagectomy.

作者信息

Ninomiya Itasu, Okamoto Koichi, Fushida Sachio, Kinoshita Jun, Takamura Hiroyuki, Tajima Hidehiro, Makino Isamu, Miyashita Tomoharu, Ohta Tetsuo

机构信息

Department of Gastroenterological Surgery, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.

出版信息

Esophagus. 2019 Jan;16(1):107-113. doi: 10.1007/s10388-018-0638-4. Epub 2018 Aug 28.

DOI:10.1007/s10388-018-0638-4

PMID:30155745

Abstract

BACKGROUND

This study was performed to clarify the optimal therapeutic strategy for recurrent disease after esophagectomy.

METHODS

We investigated the prognosis of 37 patients who developed recurrence among 128 patients who underwent curative thoracoscopic esophagectomy (TE) at Kanazawa University Hospital. The prognostic factors after recurrence were examined by univariate and multivariate analyses.

RESULTS

Of these 37 recurrences, 29 patients underwent local therapy (surgery, 10 patients; surgery followed by radiation, 2 patients; radiation, 17 patients). Radiation includes intensity-modulated radiation therapy, chemoradiation, and simple radiation therapy. Seventeen patients (58.6%) were considered to have undergone successful therapy by disappearance or diminishment of the targeted region without regrowth. Eleven of 17 patients (64.7%) showed repeat recurrence at another site. Multiple local therapy was performed for repeat recurrence or uncontrollable first therapy. Finally, 57 local therapies were performed. Using multimodal local therapy, 37 (64.9%) of 57 recurrences were successfully managed. The 12 patients treated by surgery as the initial therapy showed the most favorable survival. Seventeen patients who underwent successful initial therapy showed better survival than others. Multiple or miscellaneous organ metastasis, abdominal lymphatic recurrence and best supportive care at recurrence were statistically significant negative variables for survival after recurrence. Performance of surgery and successful therapy as the initial recurrence were statistically significant positive variables for survival after recurrence. Multivariate analysis showed that successful therapy at the initial recurrence was the only independent variable for survival after recurrence.

CONCLUSIONS

Multimodal local therapy for repeat recurrence after TE contributes to the improvement of survival after recurrence.

摘要

背景

本研究旨在明确食管癌切除术后复发疾病的最佳治疗策略。

方法

我们调查了金泽大学医院128例行根治性胸腔镜食管癌切除术（TE）患者中37例复发患者的预后情况。通过单因素和多因素分析研究复发后的预后因素。

结果

在这37例复发患者中，29例接受了局部治疗（手术，10例；手术加放疗，2例；放疗，17例）。放疗包括调强放疗、放化疗和单纯放疗。17例患者（58.6%）因靶区消失或缩小且无再生长而被认为治疗成功。17例患者中有11例（64.7%）在其他部位出现复发。对复发或初次治疗无法控制的患者进行了多次局部治疗。最终共进行了57次局部治疗。采用多模式局部治疗，57例复发中有37例（64.9%）得到成功处理。以手术作为初始治疗的12例患者生存情况最佳。17例初次治疗成功的患者生存情况优于其他患者。多器官转移或混合性转移、腹部淋巴结复发以及复发时的最佳支持治疗是复发后生存的统计学显著负性变量。手术治疗以及初次复发时治疗成功是复发后生存的统计学显著正性变量。多因素分析显示，初次复发时治疗成功是复发后生存的唯一独立变量。