局部晚期食管鳞癌新辅助放化疗联合手术治疗的临床疗效分析

目的 探讨新辅助放化疗联合手术治疗局部晚期食管鳞癌的临床疗效,并分析临床完全缓解率(cCR)与病理完全缓解率(pCR)的关系。方法 回顾性选取2001—2013年局部晚期胸段食管鳞癌患者 158例,全组均采用术前同期放化疗联合手术方式,化疗采用以铂类为基础化疗方案,放疗剂量为40 Gy,2.0 Gy/次,5 次/周。Kaplan-Meier法计算OS和DFS,Logrank法检验并单因素预后分析,Cox模型多因素预后分析。结果 全组患者的pCR率为41.1%。新辅助放化疗后 44例cCR患者中 32例(73%)达pCR,114例非cCR患者中 33例(28.9%)达pCR (P=0.000)。cCR预测pCR的敏感性、特异性分别为49.2%、87.1%,阳性、阴性预测值分别为72.7%、71.1%。3年总样本数为 53例。全组 3年OS、DFS分别为53.9%、48.6%,cCR的显著高于非cCR的(P=0.012、P=0.026),pCR的显著高于非pCR的(P=0.000、0.000)。多因素分析显示放化疗后病理反应和化疗方案是影响OS的因素。最常见≥3级急性不良反应为白细胞减少(34.2%)。结论 新辅助放化疗联合手术治疗局部晚期食管鳞癌可获得较高pCR率且不良反应可耐受,放化疗后cCR率与pCR率、OS密切相关。

Clinical efficacy of neoadjuvant chemoradiotherapy followed by surgery for locally advanced esophageal squamous cell carcinoma

Objective To explore the efficacy of neoadjuvant chemoradiotherapy (CRT) followed by surgery for locally advanced esophageal squamous cell carcinoma (ESCC), and to investigate the correlation between a clinical complete response (cCR) and a pathologic complete response (pCR). Methods One hundred and fifty-eight patients with locally advanced thoracic ESCC from 2001 to 2013 were retrospectively analyzed. All patients received concurrent chemoradiotherapy followed by surgery. Platinum-based chemotherapy regimens were adopted in chemotherapy and a prescribed dose of 40 Gy in 20 fractions, 5 fractions per week, was used in radiotherapy. The overall survival (OS) and disease-free survival (DFS) rates were calculated using the Kaplan-Meier method, and pairwise comparisons and univariate prognostic analyses were performed using the log-rank test. Multivariable prognostic analyses were performed using the Cox regression model. Results The pCR rate was 41.1% in all patients. After the treatment with neoadjuvant CRT, 32(72.7%) out of 44 patients with a cCR had a pCR, but only 33(28.9%) out of 114 patients with a non-cCR had a pCR (P=0.000). The sensitivity, specificity, positive predictive value, and negative predictive value of a cCR in predicting a pCR were 49.2%, 87.1%, 72.7%, and 71.1%, respectively. The 3-year sample size was 91. The 3-year OS and DFS rates in all patients were 53.9% and 48.6%, respectively. Patients with a cCR had significantly higher 3-year OS and DFS rates than those with a non-cCR (P=0.012;P=0.026), while patients with a pCR had significantly higher 3-year OS and DFS rates than those with a non-pCR (P=0.000;P=0.000). The multivariate analyses demonstrated that the pathologic response after CRT and chemotherapy regimen were the influencing factors for OS. The most common grade ≥3 acute adverse reaction was leucopenia (34.2%). Conclusions With a high pCR rate and tolerable adverse reactions, neoadjuvant CRT followed by surgery is a safe and effective option for locally advanced ESCC. The cCR rate after CRT is closely correlated with the pCR and OS rates.