根治性切除术后隐匿性喉返神经淋巴结转移的食管鳞癌术后放疗。
Postoperative Radiotherapy in Curatively Resected Esophageal Squamous Cell Carcinoma With Occult Recurrent Laryngeal Nerve Lymph Node Metastasis.
机构信息
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.
出版信息
Cancer Control. 2024 Jan-Dec;31:10732748241285142. doi: 10.1177/10732748241285142.
OBJECTIVES
Surgery is the mainstream treatment for early-stage esophageal squamous cell carcinoma (ESCC) and occult recurrent laryngeal nerve lymph node metastasis (RLNM) is not uncommon among those with R0 resection. The clinical value of postoperative radiotherapy (PORT) in patients with RLNM only is still controversial.
METHODS
Consecutive patients with early-stage ESCC treated with R0 resection and pathologically confirmed RLNM only from June 2012 to July 2022 were retrospectively reviewed. PORT, covering the supraclavicular and superior mediastinum area (small T-field) at a dose of 50.4 Gy for 28 fractions, was performed in some patients. Propensity score matching (PSM) was performed to balance the baseline characteristics between patients with or without PORT. Pattern of failure, disease-free survival (DFS), and overall survival (OS) were compared.
RESULTS
Among the 189 patients identified, 69 (35.5%) received PORT and the other 120 (63.5%) did not. After PSM, 154 patients were included in the matched cohort, including 62 in the PORT group and 92 in the non-PORT group. With a median follow-up of 48 (95% CI: 40.3-55.7) months, 69 patients developed their initial disease recurrence in the whole population and PORT significantly decreased the frequency of local recurrence (61.2% vs 21.4%) among those with recurrent disease. Additionally, in the PSM matched cohort, PORT significantly prolonged patients' DFS (HR 0.393, = 0.002) and OS (HR 0.462, = 0.020). Moreover, PORT remained as the independent factor associated with improved DFS (HR 0.360, = 0.001) and OS (HR 0.451, = 0.021) after multivariate Cox analyses. In addition, tumor location and pathological TNM stage were found to be independent prognostic factors associated with survival outcomes.
CONCLUSION
PORT is associated with improved DFS and OS in ESCC patients with R0 resection and RLNM only, which warrants future validation.
目的
手术是早期食管鳞状细胞癌（ESCC）的主流治疗方法，R0 切除术后隐匿性喉返神经淋巴结转移（RLNM）并不少见。对于仅存在 RLNM 的患者，术后放疗（PORT）的临床价值仍存在争议。
方法
回顾性分析 2012 年 6 月至 2022 年 7 月连续接受 R0 切除且病理证实仅存在 RLNM 的早期 ESCC 患者。对部分患者行 PORT，覆盖锁骨上和上纵隔区域（小 T 野），剂量为 50.4Gy，共 28 个分次。采用倾向评分匹配（PSM）平衡 PORT 组和非 PORT 组患者的基线特征。比较失败模式、无病生存期（DFS）和总生存期（OS）。
结果
在 189 例患者中，69 例（35.5%）接受 PORT，120 例（63.5%）未接受 PORT。PSM 后，共有 154 例患者纳入匹配队列，其中 PORT 组 62 例，非 PORT 组 92 例。中位随访 48 个月（95%CI：40.3-55.7），189 例患者中有 69 例出现首发疾病复发。PORT 显著降低复发患者局部复发率（61.2% vs 21.4%）。此外，在 PSM 匹配队列中，PORT 显著延长患者的 DFS（HR 0.393， = 0.002）和 OS（HR 0.462， = 0.020）。多因素 Cox 分析显示，PORT 仍是 DFS（HR 0.360， = 0.001）和 OS（HR 0.451， = 0.021）的独立相关因素。此外，肿瘤位置和病理 TNM 分期是与生存结局相关的独立预后因素。
结论
对于仅存在 RLNM 的 R0 切除 ESCC 患者，PORT 与改善 DFS 和 OS 相关，值得进一步验证。
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