食管癌根治性治疗后局部复发患者的预后因素分析

目的 探讨食管癌根治性治疗后局部复发患者多学科综合治疗的疗效及预后因素.方法 回顾性分析196例食管癌根治性治疗后局部复发患者的临床特点,并结合随访资料进行预后因素分析.采用Kaplan-Meier法和Log rank法比较生存率,以Cox模型进行多因素回归分析.结果 全组患者的中位生存时间为8.0个月,1、2、3年生存率分别为29.8％、5.9％和4.0％.单因素分析结果显示,复发时PS评分、首次根治性治疗后与复发的间隔时间、首次治疗方案以及复发后的治疗方案与患者的预后相关.Cox多因素回归分析的结果显示,首次治疗方案和复发后治疗方案为独立预后因素.复发后采用放化疗联合治疗、单纯放疗、单纯化疗、分子靶向治疗和对症支持治疗患者的中位生存时间分别为13.0、7.0、6.0、4.0和3.0个月(P=0.000).93例既往未曾接受过放疗而复发后行放射治疗的患者中,放疗剂量≥60 Gy者的生存时间明显长于放疗剂量＜60Gy者(P =0.000).结论 首次治疗方案和复发后治疗方案为食管癌根治性治疗后复发的独立预后因素,建议对复发患者予以积极的多学科综合治疗以进一步提高疗效.对于局部复发既往未曾接受过放疗的患者,放疗剂量应该≥60Gy.食管癌根治性治疗后复发者的预后差,有必要对其他的治疗方法(如手术、靶向治疗等)做进一步探索.

Analysis of prognostic factors in patients with locoregional recurrence of esophageal carcinoma after curative treatment

Objective The aim of this paper was to evaluate the treatment outcome of multimodal treatment for 196 patients with locoregional recurrent esophageal cancer after curative treatment and to determine the prognostic factors of recurrence. Methods One hundred and ninety six patients with locoregional recurrent esophageal cancer curatively treated in our hospital were included in this study.Kaplan-Meier method was used to analyze the survival rate.Log rank test was used to evaluate the difference between the groups.Multivariate survival analysis was conducted using a Cox proportional hazard regression model with a backward stepwise procedure.Results The overall 1-,2- and 3-year survival rates were 29.8％,5.9％ and 4.0％,respectively,with a median survival time of 8.0 months.The univariate analysis showed that ECOG PS,the interval between initial treatment and recurrence,the regimens of initial treatment and retreatment were independent prognostic factors.The multivariate analysis showed that the regimens of initial treatment and retreatment were independent prognostic factors. Retreatment methods significantly influenced the survival. The median survival time of chemoradiotherapy,radiation therapy alone,chemotherapy alone,EGFR-TKI and best supportive care were 13.0,7.0,6.0,4.0 and 3.0months,respectively ( P =0.000).Conclusions The prognosis of patients with locoregional recurrent esophageal cancer after curative treatment is poor.The main prognostic factors are the regimens of initial treatment and retreatment.Multimodal treatment including radiotherapy and chemotherapy may improve the long-term survival of the patients.