摘要
目的分析影响食管鳞癌新辅助放化疗联合手术患者预后相关因素。方法回顾分析2007-2014年行新辅助放化疗联合手术的74例T3-4N01-M期食管鳞癌患者资料，Ⅱ期26例，Ⅲ期48例。Kaplan—Meier法计算OS率并Logrank法检验和单因素分析，Cox模型多因素分析。结果TRG1，TRG2，TRG3级的1、3年OS率分别为86％、50％，85％、50％，94％、86％（P=0．049）。pCR和非pCR者1、3年OS率分别为94％、87％和85％、52％（P=0．015）。淋巴结阴性和阳性1、3年OS率分别为97％、61％和57％、36％（P=0．015）。降期和非降期1、3年OS率分别为93％、70％和67％、17％（P=0．000）。多因素分析显示淋巴结状态及是否降期是影响预后因素（P=0．028、0．015）。结论术后肿瘤缓解反应分级与患者预后密切相关，尤其pCR者可明显提高患者生存。淋巴结状态及是否降期是影响患者生存因素。
Objective To analyze the prognostic factors for esophageal squamous cell carcinoma treated with neoadjuvant chemoradiotherapy and surgery. Methods A retrospective analysis was performed among 74 patients with esophageal squamous cell carcinoma who received neoadjuvant ehemoradiotherapy and surgery from January 2007 to April 2014. All patients had preoperative stage CT3-4N0-IM0, consisting of 26 patients with stage c Ⅱ disease and 48 patients with stage cⅢ disease. Overall survival rates were estimated by the Kaplan-Meier method and compared using the Log-rank test for univariate analysis. Cox regression analysis was performed to provide multivariate analysis. Results The 1-, 3-, and 5-year overall survival （OS） rates were 85.7%, 50. 0%, and 37. 4% in patients with grade 1 tumor regression, 84. 8%, 50. 1%, and 46. 3% in patients with grade 2 tumor regression, and 93.8%, 85.6%, and 85.6% in patients with grade 3 tumor regression, respectively （P=0. 049）. The 1-, 3-, and 5-year OS rates were 93.8%, 86.5%, and 86. 5% in patients with pathologic complete response （pCR） and 85.2%, 52.4%, and 44. 5% in patients without pCR, respectively （P= 0. 015）. The 1-, 3-, and 5-year OS rates were 96. 5%, 60. 9%, and 57. 1% in patients without pathologic lymph node metastasis （ypN-） and 57. 1%, 35.7%, and 35.7% in patients with pathologic lymph node metastasis （ypN＋） , respectively （P= 0. 015）. The 1-, 3-, and 5- year OS rates were 93.3%, 70. 0%, and 62. 1% in downstaged patients and 66. 7%, 16. 7%, and 16. 7% in patients not downstaged, respectively （P= 0. 000）. The multivariate analysis revealed that the ypN status and downstaging were independent prognostic factors for survival in patients （P= 0.028; P= 0.015）. Conclusions Postoperative tumor regression grading is closely associated with prognosis. Particularly, patients with pCR have substantially improved survival. The ypN status and downstaging are independent prognostic factors for survival.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2016年第5期447-451,共5页
Chinese Journal of Radiation Oncology
关键词
食管肿瘤/放射疗法
食管肿瘤/化学疗法
食管肿瘤/外科学
预后
Esophageal neoplasms/radiotehrapy
Esophageal neoplasms/chemotherapy
Esophageal neoplasms/surgery
Prognosis
