根治性放疗获临床完全缓解食管鳞癌患者10年生存分析北大核心CSCD

目的探讨接受根治性放(化)疗后达临床完全缓解(cCR)的食管鳞癌患者长期预后情况及其失败模式。方法对2009年1月至2012年12月在河北医科大学第四医院接受治疗,并符合入组条件的183例食管鳞癌患者进行回顾性分析,分析影响患者长期预后的因素,并分析cCR患者的失败模式及其失败后的预后等情况。应用SPSS 19.0统计软件进行分析。结果截至随访日期,全组患者1、3、5、10年总生存(OS)率和无病生存(DFS)率分别为83.1%、53.4%、36.2%、12.8%和68.9%、45.9%、30.5%、12.0%;中位OS期和DFS期分别为41.3、33.4个月。多因素分析结果显示cT分期、cN分期和处方剂量为影响患者OS的独立性因素(P值分别为0.001、<0.001、0.003);而声音嘶哑、病变长度、cT分期、cN分期和处方剂量为影响患者DFS的独立性因素(P值分别为0.002、0.033、0.009、<0.001、0.003)。全组患者局部区域复发72例(39.3%),远处转移58例(31.7%),其中局部区域复发伴远处转移26例(14.2%)。治疗失败后的104例患者中接受挽救性治疗的患者的预后显著优于接受维持治疗的患者(χ^(2)=39.153,P<0.001)。结论接受根治性放(化)疗后达cCR的食管鳞癌患者长期预后仍不能令人满意,临床有必要加强其临床观察和随访。cCR患者的主要治疗失败模式为局部区域复发,进行积极挽救性治疗可显著改善预后。

Analysis of the 10-year survival results of patients with esophageal squamous cell carcinoma achieving clinical complete remission after radical radiotherapy

Objective To investigate the long-term prognosis and failure mode of patients with esophageal squamous cell carcinoma who achieved clinical complete remission (cCR) after receiving radical radio (chemo) therapy. Methods Clinical data of 183 patients with esophageal squamous cell carcinoma eligible for inclusion criteria who received treatment in our hospital from January 2009 to December 2012 were retrospectively analyzed. The factors that affected the long-term prognosis of patients were identified, and the failure mode of cCR patients and the prognosis after failure were analyzed. SPSS 19.0statistical software was used for data analysis. Results As of the follow-up date, the 1-, 3-, 5-, and 10-year overall survival (OS) rates and disease-free survival (DFS) rates of the entire group were 83.1%,53.4%,36.2%,12.8% and 68.9%,45.9%, 30.5%, 12.0%,respectively. The median OS and DFS were 41.3 months and 33.4 months. The results of multivariate analysis showed that cT staging, cN staging and prescribed dose were the independent factors affecting the OS (P=0.001, <0.001, 0.003);hoarseness, lesion length, cT staging, cN staging and prescribed dose were the independent factors that affected the DFS (P=0.002, 0.033, 0.009,<0.001, 0.003). In the whole group,72 cases (39.3%) had local regional recurrence,58 cases (31.7%) had distant metastasis, and 26 cases (14.2%) had local regional recurrence with distant metastasis. Among 104 patients after treatment failure, the prognosis of patients receiving salvage treatment was significantly better than that of their counterparts receiving maintenance treatment (χ²=39.153, P<0.001). Conclusions The long-term prognosis of patients with esophageal squamous cell carcinoma who achieved cCR after receiving radical radio (chemo) therapy is still unsatisfactory. Clinically, it is necessary to strengthen the clinical observation and follow-up of these patients. The main treatment failure mode of cCR patients is local regional recurrence. Active salvage treatment can significantly improve clinical prognosis of these patients.