T3N0M0期胸段食管鳞癌术后复发或转移的挽救治疗分析

目的 分析T₃N₀M₀期胸段食管鳞癌术后复发或转移者挽救治疗的疗效及影响因素。方法 回顾2008—2009年间第四医院收治的T₃N₀M₀期胸段食管鳞癌术后复发或转移者108例，其中局部区域复发59例、远处转移26例、局部复发+远处转移23例。复发后支持治疗53例，挽救性放疗32例、化疗9例、放化疗14例。Kaplan-Meier法计算OS率并Logrank法检验和单因素预后分析，Cox模型多因素预后分析。结果 随访率100%。全组复发后1、3、4年OS率和中位OS期分别为29.9%、16.5%、14.4%和6个月。单因素分析显示复发方式和挽救治疗与复发后OS有关(P=0.017、0.000)，多因素分析显示仅挽救治疗是影响复发后OS的唯一因素(P=0.000)。与支持治疗相比，复发后化疗、放疗和放化疗能使死亡风险分别下降约76.7%、76.7%和86.1%。结论 T₃N₀M₀期胸段食管鳞癌术后复发后疗效不佳，挽救治疗能明显改善复发后OS。

Salvage therapy for postoperative recurrence or metastasis in stage T3 N0 M0 thoracic esophageal squamous cell carcinoma

Objective To analyze the efficacy of salvage therapy for postoperative recurrence or metastasis in patients with stage T₃N₀M₀ thoracic esophageal squamous cell carcinoma (ESCC) and its influencing factors. Methods A retrospective analysis was performed in 108 patients with postoperative recurrence or metastasis in stage T₃N₀M₀ thoracic ESCC who were admitted to our hospital from 2008 to 2009. In those patients, 59 had locoregional recurrence (LR), 26 distant metastasis (DM), and 23 both LR and DM. After recurrence, 53 patients received supportive therapy, 32 salvage radiotherapy, 9 chemotherapy, and 14 chemoradiotherapy. The overall survival (OS) rates were calculated using the Kaplan-Meier method and analyzed using the log-rank test. The univariate and multivariate prognostic analyses were performed using the log-rank test and the Cox regression model, respectively. Results The follow-up rate was 100%. In all patients, the 1-, 3-, and 4-year OS rates were 29.9%, 16.5%, and 14.4%, respectively;the median OS time was 6 months. The univariate analysis showed that recurrence pattern and salvage therapy were associated with OS after recurrence (P=0.017;P=0.000). The multivariate analysis showed that salvage therapy was the only independent factor for OS after recurrence (P=0.000). Compared with supportive therapy, the risk of death after chemotherapy, radiotherapy, or chemoradiotherapy was reduced by 76.7%, 76.7%, and 86.1%, respectively. Conclusions The treatment outcomes are poor in patients with postoperative recurrence of stage T₃N₀M₀ thoracic ESCC. Salvage therapy can substantially improve OS after recurrence.