Recurrence and Survival of Thoracic Esophageal Squamous Cell Carcinoma Treated with Surgery or Definitive Chemoradiation Therapy
-
摘要:目的
分析经手术治疗或根治性放化疗的胸段食管鳞癌患者的复发部位和生存时间特征。
方法回顾性分析胸段食管鳞癌患者的复发和生存时间，应用Kaplan-Meier法分析生存时间，Cox回归模型进行多因素预后分析。
结果本研究纳入586例胸段食管鳞癌患者，其中手术组334例，放化疗组252例。手术组共有129例复发（局部区域复发36例，远处转移93例），放化疗组共有118例复发（局部区域复发79例，远处转移39例），两组复发部位的构成比差异有统计学意义（χ2=37.75，P < 0.01）。手术组和放化疗组的中位总生存时间分别为39.5月和23.5月，两者的差异具有统计学意义（P < 0.01）。
结论胸段食管鳞癌手术治疗后复发以远处转移为主，根治性放化疗后的复发则以局部区域复发为主。手术治疗的生存结果优于根治性放化疗。
Abstract:ObjectiveTo investigate the site of recurrence and overall survival (OS) in the patients with thoracic esophageal squamous cell carcinoma treated with surgery or definitive chemoradiation therapy (CRT).
MethodsWe retrospectively reviewed the recurrence and survival time of the patients with primary esophageal squamous cancer. OS was calculated using the Kaplan-Meier method. Multivariate analysis to determine the independent prognostic factors was performed by the Cox regression model.
ResultsA total of 334 patients treated with surgery and 252 treated with definitive CRT were included in this analysis. A total of 129 (36 locoregional and 93 distant) and 118 (79 locoregional and 39 distant) patients experienced the recurrence in the surgery and CRT groups, respectively (χ2=37.75, P < 0.01). The median OS were 39.5 and 23.5 months in the surgery and CRT groups, respectively (P < 0.01).
ConclusionThe sites of recurrence differ between surgery and CRT on the patients with thoracic esophageal squamous cell carcinoma. Surgery is associated with improved overall survival, compared with definitive CRT.
-
Key words:
- Esophageal squamous cell carcinoma /
- Chemoradiotherapy /
- Recurrence /
- Overall survival
-
-
![]()
图 1 手术组和放化疗组的生存曲线
Figure 1 Survival curves of surgery and chemoradio-therapy (CRT) groups
表 1 586例食管鳞癌患者特征
Table 1 Characteristics of 586 patients with esophageal squamous cell carcinoma
下载: 导出CSV
表 2 手术组和放化疗组亚组生存分析
Table 2 Subgroup survival analysis of surgery and chemoradiotherapy groups
下载: 导出CSV
表 3 手术组和放化疗组患者预后的多因素分析
Table 3 Multivariate analysis of surgery and chemoradic-therapy groups
下载: 导出CSV
-
[1] Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2): 115-32. doi: 10.3322/caac.21338
[2] Rackley T, Leong T, Foo M, et al. Definitive chemoradiotherapy for oesophageal cancer-a promising start on an exciting journey[J]. Clin Oncol (R Coll Radiol), 2015, 26(9): 533-40. https://www.researchgate.net/publication/263742737_Definitive_Chemoradiotherapy_for_Oesophageal_Cancer_-_A_Promising_Start_on_an_Exciting_Journey
[3] Shapiro J, van Lanschot JJ, Hulshof MC, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for esophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial[J]. Lancet Oncol, 2015, 16(9): 1090-8. doi: 10.1016/S1470-2045(15)00040-6
[4] Motoori M, Yano M, Ishihara R, et al. Comparison between radical esophagectomy and definitive chemoradiotherapy in patients with clinical T1bN0M0 esophageal cancer[J]. Ann Surg Oncol, 2012, 19(7): 2135-41. doi: 10.1245/s10434-012-2231-8
[5] Yamamoto S, Ishihara R, Motoori M, et al. Comparison between definitive chemoradiotherapy and esophagectomy in patients with clinical stage Ⅰ esophageal squamous cell carcinoma[J]. Am J Gastroenterol, 2011, 106(6): 1048-54. doi: 10.1038/ajg.2011.42
[6] Yamashita H, Okuma K, Seto Y, et al. A retrospective comparison of clinical outcomes and quality of life measures between definitive chemoradiation alone and radical surgery for clinical stage Ⅱ-Ⅲ esophageal carcinoma[J]. J Surg Oncol, 2009, 100(6): 435-41. doi: 10.1002/jso.v100:6
[7] Yamashita H, Nakagawa K, Yamada K, et al. A single institutional non-randomized retrospective comparison between definitive chemoradiotherapy and radical surgery in 82 Japanese patients with resectable esophageal squamous cell carcinoma[J]. Dis Esophagus, 2008, 21(5): 430-6. doi: 10.1111/des.2008.21.issue-5
[8] Tougeron D, Scotté M, Hamidou H, et al. Definitive chemoradiotherapy in patients with esophageal adenocarcinoma: an alternative to surgery?[J]. J Surg Oncol, 2012, 105(8): 761-6. doi: 10.1002/jso.v105.8
[9] Teoh AY, Yan Chiu PW, Yeung WK, et al. Long-term survival outcomes after definitive chemoradiation versus surgery in patients with resectable squamous carcinoma of the esophagus: results from a randomized controlled trial[J]. Ann Oncol, 2013, 24(1): 165-71. doi: 10.1093/annonc/mds206
[10] Teoh AY, Yan Chiu PW, Wong TC, et al. Functional performance and quality of life in patients with squamous esophageal carcinoma receiving surgery or chemoradiation: results from a randomized trial[J]. Ann Surg, 2011, 253(1): 1-5. doi: 10.1097/SLA.0b013e3181fcd991
[11] 沈文斌, 祝淑钗.食管癌术后患者放化疗临床应用研究进展[J].肿瘤防治研究, 2015, 42(6): 535-40. doi: 10.3971/j.issn.1000-8578.2015.06.001 Shen WB, Zhu SC. Progress of Clinical Application of Radiochemotherapy after Esophagectomy[J]. Zhong Liu Fang Zhi Yan Jiu, 2015, 42(6): 535-40. doi: 10.3971/j.issn.1000-8578.2015.06.001
[12] Stahl M, Stuschke M, Lehmann N, et al. Chemoradiation With and Without Surgery in Patients With Locally Advanced Squamous Cell Carcinoma of the Esophagus[J]. J Clin Oncol, 2005, 23(10): 2310-7. doi: 10.1200/JCO.2005.00.034
[13] Bedenne L, Michel P, Bouché O, et al. Chemoradiation Followed by Surgery Compared With Chemoradiation Alone in Squamous Cancer of the Esophagus: FFCD 9102[J]. J Clin Oncol, 2007, 25(10): 1160-8. doi: 10.1200/JCO.2005.04.7118
[14] van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer[J]. N Engl J Med, 2012, 366(22): 2074-84. doi: 10.1056/NEJMoa1112088
[15] Ando N, Iizuka T, Ide H, et al. Surgery plus chemotherapy compared with surgery alone for localized squamous cell carcinoma of the thoracic esophagus: a Japan Clinical Oncology Group Study-JCOG9204[J]. J Clin Oncol, 2003, 21(24): 4592-6. doi: 10.1200/JCO.2003.12.095
[16] Ando N, Kato H, Igaki H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907)[J]. Ann Surg Oncol, 2012, 19(1): 68-74. doi: 10.1245/s10434-011-2049-9
[17] Ohnuma H, Sato Y, Hirakawa M, et al. A Phase 1/2 Study of Definitive Chemoradiation Therapy Using Docetaxel, Nedaplatin, and 5-Fluorouracil (DNF-R) for Esophageal Cancer[J]. Int J Radiat Oncol Biol Phys, 2015, 93(2): 382-90. doi: 10.1016/j.ijrobp.2015.05.041
[18] Fokas E, Weiss C, Rödel C, et al. The role of radiotherapy in the multimodal management of esophageal cancer[J]. Dig Dis, 2013, 31(1): 30-7. doi: 10.1159/000347170
[19] Swisher SG, Maish M, Erasmus JJ, et al. Utility of PET, CT and EUS to identify pathologic responders in esophageal cancer[J]. Ann Thorac Surg, 2004, 78(4): 1152-60. doi: 10.1016/j.athoracsur.2004.04.046
计量
- 文章访问数: 1225
- HTML全文浏览量: 313
- PDF下载量: 606
