食管鳞状细胞癌新辅助放化疗后病理反应的临床预测因素：一项II期研究的长期结果
Clinical predictors of pathologically response after neoadjuvant chemoradiotherapy for esophageal squamous cell carcinoma: long term outcomes of a phase II study.
作者信息
Tan Zihui, Yang Hong, Wen Jing, Luo Kongjia, Liu Qianwen, Hu Yihuai, Zhang Lanjun, Liu Mengzhong, Yun Jingping, Fu Jianhua
机构信息
Guangdong Esophageal Cancer Institute, Guangzhou 510060, China.
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, , Sun Yat-sen University Cancer Center, Guangzhou 510060, China.
出版信息
J Thorac Dis. 2018 Sep;10(9):5254-5259. doi: 10.21037/jtd.2018.08.88.
BACKGROUND
A pathologically complete response (pCR) or near pCR to neoadjuvant chemoradiotherapy (NCRT) might imply a better prognosis in patients with esophageal cancer. The aim of the study is to identify clinical factors associated with a pCR or near pCR.
METHODS
We retrospectively analyzed 40 patients with radical esophagectomy after NCRT for esophageal squamous cell carcinoma (ESCC) from January 2001 to December 2006 in Sun Yat-sen University Cancer Center. Clinical factors included age, gender, weight loss, dysphagia, drinking status, smoking status, tumor location, tumor length, tumor grade, cT status, cN status, the regimen of chemotherapy and the interval between NCRT and surgery as potential predictors for a pCR or near pCR. Logistic regression was used to estimate the independent factors for a pCR or near pCR.
RESULTS
After surgical resection, 22.5% of the patients obtained the pCR. Patients with pCR had a better prognosis than those with non-pCR. However, there was no statistically significantly difference between the two groups (P=0.124). We separated the patients into pCR or near pCR (good responders, GRs) and poor responders (PR) based on the histology. GR showed better overall survival (OS) than PR (P=0.014). Univariate analysis indicated that short tumor length, good tumor grade and never drinking were associated with GR to NCRT. Using logistic regression analysis, good tumor grade was the only independent factor for the GR to NCRT (P=0.021). Cox regression revealed that weight loss, drinking status and GR were independent factors in ESCC patients with radical esophagectomy after NCRT.
CONCLUSIONS
Our study indicated that good tumor grade were an independent significant factor for the GR to NCRT. Weight loss, drinking status and GR were independent factors in patients with radical esophagectomy after NCRT. GR may improve OS of ESCC patients receiving NCRT.
背景
对新辅助放化疗（NCRT）达到病理完全缓解（pCR）或接近pCR可能意味着食管癌患者有更好的预后。本研究的目的是确定与pCR或接近pCR相关的临床因素。
方法
我们回顾性分析了2001年1月至2006年12月在中山大学肿瘤防治中心接受NCRT后行根治性食管切除术的40例食管鳞状细胞癌（ESCC）患者。临床因素包括年龄、性别、体重减轻、吞咽困难、饮酒状况、吸烟状况、肿瘤位置、肿瘤长度、肿瘤分级、cT状态、cN状态、化疗方案以及NCRT与手术之间的间隔时间，作为pCR或接近pCR的潜在预测因素。采用逻辑回归分析来估计pCR或接近pCR的独立因素。
结果
手术切除后，22.5%的患者达到pCR。达到pCR的患者比未达到pCR的患者预后更好。然而，两组之间无统计学显著差异（P=0.124）。根据组织学将患者分为pCR或接近pCR（良好反应者，GRs）和反应不佳者（PR）。GR的总生存期（OS）优于PR（P=0.014）。单因素分析表明，肿瘤长度短、肿瘤分级好和从不饮酒与对NCRT的良好反应相关。采用逻辑回归分析，良好的肿瘤分级是对NCRT良好反应的唯一独立因素（P=0.021）。Cox回归显示，体重减轻、饮酒状况和GR是NCRT后行根治性食管切除术的ESCC患者的独立因素。
结论
我们的研究表明，良好的肿瘤分级是对NCRT良好反应的独立重要因素。体重减轻、饮酒状况和GR是NCRT后行根治性食管切除术患者的独立因素。GR可能改善接受NCRT的ESCC患者的OS。
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