A retrospective study of the effect of postoperative adjuvant therapy on patients with locally advanced pT3N0M0 esophageal squamous cell carcinoma
-
摘要:
目的 探讨术后辅助治疗对于pT3N0M0食管鳞癌患者远期生存的影响。 方法 回顾性分析兰州大学第二医院2010年1月至2014年4月收治的食管鳞癌患者资料,并分为4组:单纯手术组,手术+放疗组,手术+化疗组,手术+放化疗组。收集患者的临床病理资料及远期随访结果。 结果 2010年1月至2014年4月共纳入177例患者,中位年龄61(43~78)岁。其中单纯手术组79例,术后辅助治疗组98例,其中手术+放疗组28例,手术+化疗组38例,手术+放化疗组32例。术后辅助治疗的总生存率和无瘤生存率均高于单纯手术组(P=0.012,P=0.007)。组间比较结果显示:手术+放疗组总生存率和无瘤生存率高于单纯手术组(P=0.038,P=0.011),手术+放化疗组仅总生存率高于单纯手术组(P=0.031)。 结论 pT3N0M0食管鳞癌患者可以从术后辅助放疗和放化疗中获益,尤其放疗可以达到局部区域控制的显著效果。 Abstract:Objective To evaluate the effect of postoperative adjuvant therapy on patients with locally advanced pathologic T3N0M0 (pT3N0M0) esophageal squamous cell carcinoma (ESCC). Methods In this retrospective study, we evaluated patients who underwent esophagectomy at Lanzhou University Second Hospital. Patients were divided into 4 groups: surgery-alone (S), surgery + radiotherapy group (S+RT), surgery + chemotherapy (S+CT), and surgery + chemoradiotherapy (S+CRT) groups. Both the clinicopathologic information and the long-term follow-up results were analyzed. Results From January 2010 to April 2014, a total of 177 patients with a median age of 61 years (range 43-78), were enrolled into the study. Among them, 79 received surgery alone; the remaining 98 patients received adjuvant therapy, of whom 28 patients received adjuvant radiotherapy, 38 received adjuvant chemotherapy, and 32 received adjuvant chemoradiotherapy. Overall survival and disease-free survival were better in Group S+Adjuvant than in Group S (P=0.012, P= 0.007, respectively). Comparisons among the four groups showed that the overall survival was higher in Group S+CRT than in Group S (P=0.031). Group S+RT was associated with better overall survival and disease-free survival than Group S (P=0.038, P=0.011, respectively). Conclusions Patients with pT3N0M0 ESCC could benefit from adjuvant radiotherapy and chemoradiotherapy, as radiotherapy could help achieve better locoregional control. -
表 1 四组患者的基本临床资料 例
-
[1] Bray. F, Jemal. A, Grey. N, et al. Global cancer transitions according to the Human Development Index (2008-2030): a populationbased study[J]. Lancet Oncol, 2012, 13:790-801. doi: 10.1016/S1470-2045(12)70211-5 [2] Ye B, Zhong CX, Yang Y, et al. Lymph node dissection in esophageal carcinoma: Minimally invasive esophagectomy versus open surgery [J]. World J Gastroenterol, 2016, 22:4750-4756. doi: 10.3748/wjg.v22.i19.4750 [3] Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients[J]. Ann Surg, 2012, 256:95-103. doi: 10.1097/SLA.0b013e3182590603 [4] Dolan JP, Kaur T, Diggs BS, et al. Impact of comorbidity on outcomes and overall survival after open and minimally invasive esophagectomy for locally advanced esophageal cancer[J]. Surgical endoscopy, 2013, 27(11):4094-4103. doi: 10.1007/s00464-013-3066-5 [5] Singh. RK, Pham. TH, Diggs. BS, et al. Minimally Invasive Esophagectomy Provides Equivalent Oncologic Outcomes to Open Esophagectomy for Locally Advanced (Stage Ⅱ or Ⅲ) Esophageal Carcinoma[J]. Arch Surg, 2011, 146(6):711-714. doi: 10.1001/archsurg.2011.146 [6] Wong AT, Shao M, Rineer J, et al. The Impact of Adjuvant Postoperative Radiation Therapy and Chemotherapy on Survival After Esophagectomy for Esophageal Carcinoma[J]. ANN SURG, 2017, 265(6):1146-1151. doi: 10.1097/SLA.0000000000001825 [7] Xu Y, Liu J, Du X, et al. Prognostic impact of postoperative radiation in patients undergoing radical esophagectomy for pathologic lymph node positive esophageal cancer[J]. RADIAT ONCOL, 2013, 8: 116. doi: 10.1186/1748-717X-8-116 [8] Schreiber D, Rineer J, Vongtama D, et al. Impact of Postoperative Radiation after Esophagectomy for Esophageal Cancer[J]. J Thorac Oncol, 2010, 5(2):244-250. doi: 10.1097/JTO.0b013e3181c5e34f [9] Xiao ZF, Yang ZY, Liang J, et al. Value of Radiotherapy After Radical Surgery for Esophageal Carcinoma: A Report of 495 Patients[J]. Ann Thorac Surg, 2003, 75(2):331-316. doi: 10.1016/S0003-4975(02)04401-6 [10] Pasquali S, Yim G, Vohra RS, et al. Survival After Neoadjuvant and Adjuvant Treatments Compared to Surgery Alone for Resectable Esophageal Carcinoma[J]. Ann Surg, 2017, 265(3):481-491. doi: 10.1097/SLA.0000000000001905 [11] Yang J, Zhang W, Xiao Z, et al. The Impact of Postoperative Conformal Radiotherapy after Radical Surgery on Survival and Recurrence in Pathologic T3N0M0 Esophageal Carcinoma: A Propensity ScoreMatched Analysis[J]. J Thorac Oncol, 2017, 12(7):1143-1151. doi: 10.1016/j.jtho.2017.03.024 [12] Pennathur A, Gibson MK, Jobe BA, et al. Oesophageal carcinoma[J]. Lancet, 2013, 381(9864):400-412. doi: 10.1016/S0140-6736(12)60643-6 [13] Shapiro J, van Lanschot JJ, Hulshof MC, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial[J]. LANCET ONCOL, 2015, 16(9):1090-1098. doi: 10.1016/S1470-2045(15)00040-6 [14] Mantziari S, Gronnier C, Renaud F, et al. Survival Benefit of Neoadjuvant Treatment in Clinical T3N0M0 Esophageal Cancer[J]. Ann Surg, 2017, 266(5):805-813. doi: 10.1097/SLA.0000000000002402 [15] Jaffer A. Ajani, Thomas A. D Amico, Khaldoun Almhanna, et al. Esophageal and Esophagogastric Junction Cancers, Version 1, 2015 [J]. J Natl Compr Canc Netw, 2015, 13(2):194-227. doi: 10.6004/jnccn.2015.0028 [16] Ando N, Iizuka T, Ide H, et al. Surgery plus chemotherapy compared with surgery alone for localized squamous cell carcinoma of the thoracic esophagus: a Japan Clinical Oncology Group Study--JCOG9204[J]. J Clin Oncol, 2003, 15; 21(24):4592-4596. http://europepmc.org/abstract/MED/14673047 [17] Li L, Zhao L, Lin B, et al. Adjuvant Therapeutic Modalities Following Three-field Lymph Node Dissection for Stage Ⅱ/Ⅲ Esophageal Squamous Cell Carcinoma[J]. J Cancer, 2017, 5;8(11):2051-2059. http://europepmc.org/articles/PMC5559967/ [18] 王玉祥, 王丽丽, 杨琼, 等.pT3N0M0期胸段食管鳞癌根治术后的预后因素[J].肿瘤防治研究, 2016, 43(6):483-488. http://d.old.wanfangdata.com.cn/Periodical/zlfzyj201606010 [19] Gertler R, Stein HJ, Schuster T, et al. Prevalence and topography of lymph node metastases in early esophageal and gastric cancer[J]. Ann Surg, 2014, 259(1):96-101. doi: 10.1097/SLA.0000000000000239