Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Department of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan.
Esophagus. 2021 Apr;18(2):288-295. doi: 10.1007/s10388-020-00790-1. Epub 2020 Oct 27.
The significance of postoperative radiotherapy for residual disease after esophageal cancer surgery remains controversial. The purpose of this study was to elucidate the efficacy of postoperative radiotherapy in esophageal squamous cell carcinoma (ESCC) patients with positive circumferential resection margin (CRM).
We retrospectively analyzed data from 1190 patients who underwent esophagectomy for ESCC at our hospital from 2005 to 2018, of whom 61 (5.1%) patients were diagnosed with positive CRM of ESCC. Overall survival (OS), progression-specific survival (PSS), local progression-specific survival (LPSS), and clinicopathological factors were compared between patients with and without postoperative radiotherapy. The efficacy of additional radiotherapy on patient outcomes was evaluated.
Among the 61 patients analyzed, 29 (47.5%) underwent radiotherapy (RT group) and 32 (52.5%) did not (NRT group). In the RT group, 22 patients (75.9%) received radiotherapy and 7 patients (24.1%) received chemoradiotherapy. The RT group included younger patients, a greater number of upper-esophageal tumors, and a greater rate of R2 resections than the NRT group. The LPSS and PSS of the RT group were significantly better than those of the NRT group (P = 0.007, P < 0.001, respectively). In multivariate analysis, postoperative radiotherapy was an independent factor for LPSS [P < 0.001; hazard ratio (HR) 0.17; 95% confidence interval (CI) 0.06-0.46] and PSS (P < 0.001; HR 0.31; 95% CI 0.16-0.60).
Postoperative radiotherapy contributed to the control of residual tumor and was significantly associated with better LPSS and PSS among patients with positive CRM after esophagectomy for ESCC.
食管癌手术后残留疾病的术后放疗意义仍存在争议。本研究旨在阐明阳性环周切缘（CRM）的食管鳞癌（ESCC）患者术后放疗的疗效。
我们回顾性分析了 2005 年至 2018 年我院 1190 例 ESCC 患者行食管癌切除术的资料，其中 61 例（5.1%）患者被诊断为 ESCC 阳性 CRM。比较了术后放疗（RT 组）和未放疗（NRT 组）患者的总生存（OS）、疾病特异性生存（PSS）、局部进展特异性生存（LPSS）和临床病理因素。评估了附加放疗对患者结局的影响。
在分析的 61 例患者中，29 例（47.5%）接受了放疗（RT 组），32 例（52.5%）未接受放疗（NRT 组）。在 RT 组中，22 例（75.9%）接受了单纯放疗，7 例（24.1%）接受了放化疗。RT 组患者较年轻，更多为食管上段肿瘤，R2 切除率也较高。RT 组的 LPSS 和 PSS 明显优于 NRT 组（P=0.007，P<0.001）。多因素分析显示，术后放疗是 LPSS（P<0.001；风险比[HR]0.17；95%置信区间[CI]0.06-0.46）和 PSS（P<0.001；HR 0.31；95%CI 0.16-0.60）的独立预后因素。
术后放疗有助于控制残留肿瘤，在 ESCC 术后 CRM 阳性患者中，与 LPSS 和 PSS 的改善显著相关。
