Patterns of Failure After Radical Surgery on Patients with StageⅡ/Ⅲ Thoracic Esophageal Squamous Cell Carcinoma
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摘要:目的
比较Ⅱ和Ⅲ期胸段食管鳞癌患者单纯手术、术后放疗（PORT）和术后放化疗（POCRT）患者的失败模式，探讨适合不同亚组人群的最佳治疗模式。
方法回顾性分析468例不同治疗方式Ⅱ和Ⅲ期胸段食管鳞癌术后患者的临床病理特征和失败模式的关系，应用SPSS19.0软件进行统计分析。
结果全组患者胸腔-区域复发率为40.8%，远处转移率为27.4%。三组患者的1、3、5年胸腔-区域复发率差异有统计学意义，而三组间远处转移率差异未见有统计学意义。POCRT与单纯手术和PORT组患者相比胸腔内复发率较低；而单纯手术组患者较POCRT和PORT组患者远处转移率低。Ⅲ期较Ⅱ期患者的血行转移率高。与N0期相比，N1期患者锁骨上及腹腔淋巴结复发率和血行转移率均较高（P < 0.05）。N0期患者接受术后辅助性治疗后，胸腔内复发率显著低于单纯手术患者，且N1期患者似乎更能从POCRT中受益。Ⅱ期患者中接受术后辅助治疗的其锁骨上淋巴复发率和胸腔内复发率均显著低于单纯手术患者，但Ⅱ/Ⅲ期接受术后辅助性治疗的患者的远处转移率要高于单纯手术患者。
结论Ⅱ期和Ⅲ期食管癌有较高的胸腔-区域复发率和远处转移率，POCRT较PORT能显著降低患者的胸腔-区域复发率；建议Ⅱ期和N1期食管癌术后患者常规应用放化联合治疗。
Abstract:ObjectiveTo compare the failure modes of the patients with stage Ⅱ and stage Ⅲ thoracic esophageal squamous cell carcinoma (TESCC) treated with surgery, postoperative radiotherapy (PORT) and postoperative radiotherapy and chemotherapy (POCRT), and to explore the best treatment model for different subgroups.
MethodsWe retrospectively analyzed 468 patients treated with different treatment with stage Ⅱ and Ⅲ TESCC after radical resection, and analyzed the relation between their clinicopathological characteristics and the failure modes. SPSS19.0 statistical software was used for statistical analysis.
ResultsThe thoracic-regional recurrence rate was 40.8%, and the distant metastasis rate was 27.4% in the whole group. The 1, 3, 5 years-thoracic-regional recurrence rates were significantly different among the three groups. The distant metastasis rates were not significant among the three groups. Compared with surgery and PORT groups, POCRT group had lower intrathoracic recurrence rate; but, the surgery group had lower distant metastasis rate. Compared with stage Ⅱ patients, stage Ⅲ patients had higher distant metastasis rate. Compared with N0 stage patients, the patients with N1 stage had significantly higher supraclavicular and abdominal lymph node recurrence rate and higher distant metastasis rate. The intrathoracic recurrence rate of N0 stage patients who received postoperative adjuvant therapy were significantly lower than that in patients who received surgery alone, and N1 stage patients seemed to be able to benefit from POCRT. The supraclavicular lymph recurrence rate and intrathoracic recurrence rate of stageⅡpatients who received postoperative adjuvant treatment were significantly lower than those who received surgery alone, but the distant metastasis rates of stage Ⅱ/Ⅲ patients who received postoperative adjuvant therapy were higher than those who received surgery alone.
ConclusionThere are high thoracic-regional recurrence rate and distant metastasis rate in the patients with stageⅡ/Ⅲesophageal squamous cell carcinoma after radical surgery. Compared with PORT, POCRT can significantly reduce the thoracic-region recurrence rate. It is recommended that POCRT could be applied on stageⅡor N1 esophageal cancer patients.
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Key words:
- Esophageal neoplasm /
- Surgery /
- Postoperative /
- Radiotherapy /
- Chemoradiotherapy /
- Failure mode
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图 1 食管癌术后不同辅助治疗模式治疗后的各组复发率 (A) 及远处转移率 (B)
Figure 1 Chest-regional recurrence (A) and distant metastasis (B) curves of different treatment models
表 1 不同治疗方式患者的一般临床病理资料构成比比较
Table 1 Comparison of general clinical pathologic data of different treatments groups
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表 3 不同TNM分期患者的失败模式比较结果
Table 3 Comparison of failure modes on patients with different TNM stages
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表 4 不同N分期患者的失败模式比较
Table 4 Comparison of failure modes on patients with different N stages
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表 5 不同N分期接受不同治疗方式患者的失败模式比较 (n(%))
Table 5 Comparison of failure modes of Surgery, PORT and POCRT on patients with different N stages (n(%))
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表 6 不同TNM分期接受不同治疗方式患者的失败模式比较 (n(%))
Table 6 Comparison of failure modes of Surgery, PORT and POCRT on patients with different TNM stages (n(%))
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