食管鳞癌术后局部区域复发患者接受不同照射方式获益人群的初步分析

目的 探讨胸段食管鳞癌患者术后局部区域复发接受放疗患者不同照射方式的人群获益情况。方法 回顾性分析2009-2014年间河北医科大学第四医院 344例食管癌术后复发接受了调强适形放疗或同步化放疗患者的病历资料,分析患者的复发部位分布的情况、预后影响因素,并对接受选择性淋巴结照射(ENI)和累及野照射(IFI)两种方式的获益人群进行分层分析。结果 术后单区域复发 276例(80.2%),其中≥2个区域复发 68例(19.8%)。随访率96.2%。全组患者1、3、5年总生存率分别为53.6%、22.6%、16.4%,中位生存期12.8个月(95%CI为 11.3~14.3个月);1、3、5年无局部复发生存率分别为46.5%、16.9%、12.0%,中位生存期11.0个月(95%CI为 9.6~12.4个月);1、3、5年无进展生存率分别为39.8%、11.3%、6.7%,中位生存期7.9个月(95%CI为 5.8~10.0个月)。全组多因素分析结果显示患者性别、阳性淋巴结对数比(LODDS)、化疗周期数均为患者预后的独立影响因素(P=0.003、<0.001、<0.001)。亚组单因素分析结果显示对食管病变长度<5.0cm、N0期、手术清扫淋巴结≤9个、术后阳性淋巴结转移区域数为0个、LODDS≤0.030患者进行ENI可使其受益(P=0.032、0.012、0.001、0.012、0.014);而对手术清扫淋巴结≥16个患者进行IFI可使其获益(P=0.035)。结论 放疗为食管癌术后局部区域复发患者的有效治疗模式,对于术前食管造影显示食管病变较短、术后病理N分期较早、LODDS评分较低和清扫淋巴结数目较少者可能应用ENI较IFI更能使其获益;而术中清扫淋巴结数目较多患者可能应用IFI较ENI更能使其获益。

Preliminary analysis of the benefit groups of patients with locoregional recurrence of esophageal squamous cell carcinoma who received different patterns of irradiation

Objective To explore the benefit groups of patients with locoregional recurrence of esophageal thoracic squamous cell carcinoma who received radiotherapy or chemoradiotherapy with different patterns of irradiation. Methods Clinical data of 344 esophageal thoracic squamous cell carcinoma patients with postoperative recurrence who received intensity conformal radiotherapy or concurrent chemoradiotherapy in the Fourth Hospital of Hebei Medical University from 2009 to 2014 were retrospectively analyzed. The distribution of recurrence sites and prognostic factors were analyzed. A stratified analysis was carried out on the benefit groups of patients receiving the elective nodal irradiation (ENI) and involved field irradiation (IFI). Results 276 cases (80.2%) recurred at a single site and 68 cases (19.8%) recurred at more than two sites. The follow-up rate was 96.2%. The 1-, 3-and 5-year overall survival rates were 53.6%, 22.6% and 16.4%, respectively, with a median of 12.8 months (95%CI:11.3-14.3 months). The 1-, 3-and 5-year local recurrence-free survival rates were 46.5%, 16.9% and 12.0%, respectively, with a median of 11.0 months (95%CI:9.6-12.4 months). The 1-, 3-and 5-year progression-free survival rates were 39.8%, 11.3% and 6.7%, respectively, with a median of 7.9 months (95%CI:5.8-10.0 months). Multivariate analysis showed that gender, the log odds of metastatic lymph nodes (LODDS) and the number of chemotherapy cycles were the independent prognostic factors (P=0.003,<0.001,<0.001). Subgroup univariate analysis demonstrated that patients with an esophageal lesion length<5.0cm,N0stage, the number of surgically-dissected lymph nodes of ≤9,the number of postoperative positive lymph node metastasis site of 0, and LODDS≤0.030 obtained benefits from ENI (P=0.032,0.012,0.001,0.012 and 0.014). Patients with the number of surgically-dissected lymph nodes of ≥16 achieved benefits from IFI (P=0.035). Conclusions Radiotherapy is an effective treatment mode for patients with local recurrence after esophageal cancer surgery. For patients with preoperative esophagography showing shorter esophageal lesions, earlier postoperative pathological N stage, lower LODDS score, and fewer surgically-dissected lymph nodes probably obtain more benefits from ENI than IFI. However, patients with more surgically-dissected lymph nodes may obtain more benefit from IFI compared with ENI.