Cui Tiantian, Chen Huajian, Fan Min, Huang Wei, Liu Xiaodong
School of Public Health, Wenzhou Medical University, Wenzhou, Zhejiang, China.
Department V of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
BMC Cancer. 2025 Jul 30;25(1):1245. doi: 10.1186/s12885-025-14671-2.
This investigation delineates the differential impact of recurrence patterns-specifically, anastomotic recurrence (AR) and lymph node recurrence (LNR)-on the survival outcomes of patients with esophageal squamous cell carcinoma (ESCC). Additionally, it assesses the therapeutic efficacy of adjuvant radiotherapy in modifying these postoperative recurrence dynamics to inform optimized clinical management.
A retrospective cohort analysis was conducted on 434 patients who developed recurrent ESCC following radical surgery at Shandong Cancer Hospital, from July 2018 through December 2022. Comprehensive clinical data were analyzed using logistic and Cox proportional hazards regression models to elucidate the risk factors associated with AR and LNR.
Of the patients analyzed, 118 exhibited AR post-surgery. Multivariate logistic regression identified advanced N stage and the presence of LNR as predominant risk factors influencing recurrence. Survival analysis, employing Kaplan-Meier estimates, demonstrated a median survival time (MST) of 21 months (range: 1.6-146.1 months) for patients with AR. In patients experiencing LNR, Cox regression analyses revealed tumor location and the application of adjuvant radiotherapy as critical determinants of survival outcomes. Significantly, adjuvant radiotherapy markedly reduced the incidence of LNR, thereby attenuating overall recurrence rates.
Postoperative recurrence significantly compromises survival in ESCC, underscoring the critical need for precise risk stratification and proactive management. This study substantiates the prognostic significance of adjuvant radiotherapy in reducing recurrence, providing pivotal insights for tailoring treatment protocols to enhance patient prognoses in ESCC.
本研究阐述了复发模式——特别是吻合口复发（AR）和淋巴结复发（LNR）——对食管鳞状细胞癌（ESCC）患者生存结局的不同影响。此外，本研究评估了辅助放疗在改变这些术后复发动态方面的治疗效果，以为优化临床管理提供依据。
对2018年7月至2022年12月在山东省肿瘤医院接受根治性手术后发生复发性ESCC的434例患者进行了回顾性队列分析。使用逻辑回归和Cox比例风险回归模型分析综合临床数据，以阐明与AR和LNR相关的危险因素。
在分析的患者中，118例术后出现AR。多因素逻辑回归确定晚期N分期和LNR的存在是影响复发的主要危险因素。采用Kaplan-Meier估计的生存分析显示，AR患者的中位生存时间（MST）为21个月（范围：1.6 - 146.1个月）。在发生LNR的患者中，Cox回归分析显示肿瘤位置和辅助放疗的应用是生存结局的关键决定因素。值得注意的是，辅助放疗显著降低了LNR的发生率，从而降低了总体复发率。
术后复发显著影响ESCC患者的生存，强调了精确风险分层和积极管理的迫切需求。本研究证实了辅助放疗在降低复发方面的预后意义，为制定治疗方案以改善ESCC患者的预后提供了关键见解。
