182例胸段食管癌根治术后残端不典型增生及癌残留治疗模式探讨

目的 回顾性分析食管癌术后残端不典型增生及癌残留患者不同治疗方式的疗效。方法 选择胸段食管癌根治术后残端不典型增生及癌残留患者 182例,其中采用术后放疗(RT)40例,术后化疗(CT)48例,术后放化疗(RCT)32例,术后未治疗(NT)62例,比较治疗状况对全组及不同病理分期的疗效差异。Kaplan-Meier法计算局部控制率、总生存率并Logrank检验,Cox回归模型进行多因素分析。结果 随访率为93.4%,随访时间满2、3年者分别为88、38例。局部复发率残端不典型增生Ⅰ~Ⅱ级为22%、Ⅲ级加原位癌为35%、浸润癌为36%(χ²=3.49,P=0.175)。全组RT,CT,RCT,NT的2、3年局部控制率分别为81%、81%,61%、57%,73%、73%,49%、42%(χ²=13.38,P=0.004),残端不典型增生Ⅰ~Ⅱ级的分别为100%、100%,77%、68%,100%、100%,60%、45%(χ²=7.09,P=0.069);全组的总生存率分别为85%、74%,67%、48%,73%、56%,44%、26%(χ²=20.24,P=0.000),残端不典型增生Ⅰ~Ⅱ级的分别为100%、100%,79%、54%,33%、33%,75%、34%(χ²=9.89,P=0.020),病理分期Ⅰ~Ⅱ期残端阳性的分别为80%、80%,55%、55%,93%、77%,38%、30%(χ²=12.34,P=0.006)。结论 食管癌术后残端不典型增生Ⅰ~Ⅱ级和残端阳性均有较高的局部复发率,残端不典型增生Ⅰ~Ⅱ级及残端阳性Ⅰ~Ⅱ期患者推荐采用术后RT,Ⅲ期患者采用术后RCT可能较为合理。

Treatment modalities in 182 thoracic esophageal cancer patients with atypical hyperplasia in esophageal stump and esophageal stump cancer after esophagectomy

Objective To retrospectively analyze the therapeutic effects of different treatment modalities in thoracic esophageal cancer (EC) patients with atypical hyperplasia in the esophageal stump and esophageal stump cancer after esophagectomy. Methods From August 2006 to December 2010, 182 thoracic EC patients with atypical hyperplasia in the esophageal stump and esophageal stump cancer after esophagectomy were included in the study. Of the patients, 40 received postoperative radiotherapy (RT), 48 received postoperative chemotherapy (CT), 32 received postoperative radiochemotherapy (RCT), and 62 received no treatment (NT) after operation. The therapeutic effects of different treatment modalities were compared in all patients, in patients with atypical hyperplasia in the esophageal stump after esophagectomy, and in patients with esophageal stump cancer after esophagectomy. The Kaplan-Meier method was used to calculate local control (LC) and overall survival (OS) rates, and the logrank test was used for survival difference analysis. The Cox model was used for multivariate prognostic analysis. Results The follow-up rate was 93.4%;88 patients were followed up for at least 2 years, and 38 for at least 3 years. The local recurrence (LR) rates were 22% in the patients with grade Ⅰ—Ⅱ atypical hyperplasia in the esophageal stump, 35% in the patients with grade Ⅲ atypical hyperplasia in the esophageal stump and carcinoma in situ, and 36% in the patients with invasive carcinoma (χ²=3.49, P=0.175). For all patients, the 2-and 3-year LC rates were 81% and 81% in those receiving RT, 61% and 57% in those receiving CT, 73% and 73% in those receiving RCT, and 49% and 42% in those receiving NT (χ²=13.38, P=0.004). For the patients with grade Ⅰ—Ⅱ atypical hyperplasia in the esophageal stump, the 2-and 3-year LC rates were 100% and 100% in those receiving RT, 77% and 68% in those receiving CT, 100% and 100% in those receiving RCT, and 60% and 45% in those receiving NT (χ²=7.09,P=0.069). For all patients, the 2- and 3-year OS rates were 85% and 74% in thosereceiving RT, 67% and 48% in those receiving CT, 73% and 56% in those receiving RCT, and 44% and 26% in those receiving NT (χ²=20.24, P=0.000). For the patients with grade Ⅰ—Ⅱ atypical hyperplasia in the esophageal stump, the 2-and 3-year OS rates were 100% and 100% in those receiving RT, 79% and 54% in those receiving CT, 33% and 33% in those receiving RCT, and 75% and 34% in those receiving NT (χ²=9.89,P=0.020). For the patients with grade Ⅰ—Ⅱ positive esophageal stump, the 2-and 3-year OS rates were 80% and 80% in those receiving RT, 55% and 55% in those receiving CT, 93% and 77% in those receiving RCT, and 38% and 30% in those receiving NT (χ²=12.34, P=0.006). Conclusions The thoracic EC patients with grade Ⅰ—Ⅱ atypical hyperplasia in the esophageal stump and positive esophageal stump after esophagectomy have high LR rates. Postoperative RT is recommended for the patients with grade Ⅰ—Ⅱ atypical hyperplasia in the esophageal stump and the patients with grade Ⅰ—Ⅱ positive esophageal stump, while it may be reasonable to recommend postoperative RCT for the patients with grade Ⅲ positive esophageal stump.