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胸段食管癌微创术后治疗失败模式及辅助治疗价值 被引量:1

Patterns of treatment failure after minimally invasive esophagectomy among patients with thoracic esophageal carcinoma:implications for value of adjuvant therapy
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摘要 目的观察胸段食管癌患者微创手术后的总复发率及治疗失败模式,评估术后辅助治疗的价值。方法回顾性分析河北医科大学第四医院2016—2018年直接行微创手术及新辅助化疗后行微创手术的胸段食管癌患者临床资料。所有患者均采用微创食管癌根治性切除术治疗。采用SPSS 26.0软件统计分析其基于术后病理的淋巴结转移率、疾病总复发率和治疗失败模式,采用Cox回归模型筛选肿瘤复发的高危因素。采用倾向性评分匹配对比术后放疗组与未行放疗组生存情况。结果纳入患者443例,全组淋巴结转移率为42.0%,全组疾病总复发率为34.8%,最常见的复发模式是区域性淋巴结转移和远处转移(24.2%和19.4%)。多因素Cox回归分析显示,pT3-4期、pN+期为肿瘤复发的独立危险因素。清扫淋巴结总数目≥12枚及颈部锁骨上+上纵隔清扫淋巴结数目≥7枚可降低肿瘤复发风险。术后放疗组与未行放疗组的1、3、5年无瘤生存率分别为83.5%、66.8%、60.7%和79.2%、61.6%、57.2%(χ2=0.13,P=0.715),两组1、3、5年总生存率分别为92.0%、72.0%、67.5%和84.0%、68.0%、55.4%(χ2=0.43,P=0.513)。结论对于食管癌微创手术患者,在直接手术或仅行新辅助化疗情况下,术后区域性淋巴结转移和远处转移是主要治疗失败模式。pT3-4期、pN+期、淋巴结清扫总数目及颈部锁骨上+上纵隔清扫淋巴结数目不足是术后复发高危因素,术后放疗组的生存率有高于未行放疗组的趋势,包括术后放疗的辅助治疗可能仍然有其必要性。 Objective To investigate the overall recurrence rate and the pattern of treatment failure in thoracic esophageal cancer(TEC)patients after minimally invasive esophagectomy(MIE),and to evaluate the significance of adjuvant therapy after MIE.Methods Clinical data of TEC patients who underwent MIE with or without neoadjuvant chemotherapy in the Fourth Hospital of Hebei Medical University between 2016 and 2018 were retrospectively analyzed.The pathology-based lymph node metastasis(LNM)rate,overall recurrence rate,and pattern of treatment failure following MIE were analyzed by SPSS 26.0 statistical software.Cox regression model was used to identify the high-risk factors for recurrent disease.Propensity score matching was performed to compare the survival of patients between the postoperative radiotherapy group and non-radiotherapy group.Results A total of 443 eligible patients were enrolled in this study,and the pathology-based LNM rate in all groups was 42.0%.The overall recurrence rate was 34.8%.Regional lymphatic metastasis was the most frequent pattern of recurrence(24.2%),followed by distant metastasis(19.4%).Multivariate Cox regression analysis identified pT3-4 stage and pN+stage as the independent risk factors for recurrence.At the same time,the total number of lymph nodes dissected≥12 and the number of lymph nodes dissected≥7 in the neck clavicle and upper mediastinum could reduce the risk of tumor recurrence.The 1-,3-,and 5-year disease-free survival(DFS)rates in the postoperative radiotherapy group and non-radiotherapy group were 83.5%,66.8%,60.7%,and 79.2%,61.6%,57.2%,respectively(χ2=0.13,P=0.715).The 1-,3-,and 5-year overall survival(OS)rates in two groups were 92.0%,72.0%,67.5%and 84.0%,68.0%,55.4%,respectively(χ2=0.43,P=0.513).Conclusions Regional lymphatic and distant metastases are the main patterns of recurrence for TEC patients after MIE with or without neoadjuvant chemotherapy.pT3-4 stage,pN+stage,insufficient total number of lymph node dissection and insufficient number of lymph nodes in neck
作者 程如田 王琪 王澜 刘力坤 刘俊峰 韩春 韩晶 刘树堂 Cheng Rutian;Wang Qi;Wang Lan;Liu Likun;Liu Junfeng;Han Chun;Han Jing;Liu Shutang(Department of Radiation Oncology,The Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China;Department of Thoracic Surgery,The Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China;Department of Medical Oncology,The Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China)
出处 《中华放射肿瘤学杂志》 CSCD 北大核心 2024年第1期19-26,共8页 Chinese Journal of Radiation Oncology
基金 河北省卫生健康委科研基金项目(重点科技研究计划)(20210249) 河北省适用医学跟踪项目(GZ2021036)。
关键词 食管肿瘤 微创食管切除术 复发模式 辅助治疗 术后放射疗法 Esophageal neoplasms Minimally invasive esophagectomy Pattern of recurrence Adjuvant therapy Postoperative radiotherapy
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