胸段食管鳞癌根治术后淋巴结阳性患者不同治疗方式比较

目的 比较胸段食管鳞癌(TESCC)根治术后淋巴结阳性患者不同治疗方式的疗效,探讨其最佳治疗模式。方法 回顾性分析2007—2010年间 548例TESCC根治术后淋巴结阳性患者,分析其不同治疗方式的疗效情况,并应用倾向得分匹配(PSM)对不同治疗方式组患者进行1∶1配比,进一步分析并明确适合患者的最佳治疗模式。Kaplan-Meier法计算生存率,Logrank法单因素预后分析,Cox模型行多因素预后分析。结果 1、3、5年OS分别为79.9%、38.1%、28.5%,DFS分别为68.5%、39.8%、32.5%。经PSM配比后单纯手术、PORT、POCT和POCRT组患者均有可比性,1、3、5年OS和DFS差异均有统计学意义(P均=0.000)。N1、N2和N3期患者OS和DFS差异亦均有统计学意义(P均=0.000)。多因素分析显示治疗方式和N分期均为影响患者OS和DFS的影响因素(P=0.001、0.000和0.025、0.016)。结论 TESCC根治术后淋巴结阳性者预后较差且淋巴结转移数目越多则预后越差,行术后放化疗可能会提高患者生存。

Comparison of different treatment modalities in node-positive patients after radical resection for squamous cell carcinoma of the thoracic esophagus

Objective To compare the efficacy between different modalities in the treatment of positive lymph nodes after radical resection for squamous cell carcinoma of thoracic esophagus (TESCC),and to explore the best treatment mode. The Kaplan-Meier method was used to calculate survival rates. The log-rank test and Cox model were used for univariate and multivariate prognostic analyses,respectively. Methods A retrospective analysis was performed among 548 patients with TESCC who were admitted to our hospital and had positive lymph nodes after radical resection. The efficacy of different treatment methods was evaluated. Propensity scores (PSM) were used to make 1-to-1 patient matching between different treatment groups to further analyze and figure out the best treatment model for patients. The Kaplan-Meier method was used to calculate the overall survival (OS) and disease-free survival (DFS) rates. The log-rank test was used for survival analysis and univariate prognostic analysis. The Cox regression model was used for multivariate prognostic analysis. Results In all patients,the 1-,3-,and 5-year OS rates were 79.9%,38.1% and 28.5%,respectively,while the 1-,3-,and 5-year DFS rates were 68.5%,39.8% and 32.5%,respectively. After 1-to-1 matching based on PSM,there were no differences in general clinical pathological data between the four groups. After PSM,there were significant differences in 1-,3-,and 5-year OS and DFS rates between the surgery alone group,the postoperative radiotherapy group,the postoperative chemotherapy group,and the postoperative chemoradiotherapy (POCRT) group (P=0.000,0.000).There were significant differences in OS and DFS rates between patients with stage N1,N2,and N3 disease (P=0.000,0.000).The result of the Cox multivariate analysis showed that treatment method and N staging were two independent prognostic factors for OS and DFS (P=0.001,0.000,0.025,0.016). Conclusions Patients with positive lymph nodes after radical resection for TESCC have a poor prognosis. Moreover,the prognosis becomes worse with the increase in metastatic lymph nodes. POCRT may improve the survival in those patients. Prospective studies are needed to further confirm those conclusions.