国际肿瘤学杂志

国际肿瘤学杂志››2022,Vol. 49››Issue (6): 334-339.doi:10.3760/cma.j.cn371439-20220325-00063

• 论著 •上一篇下一篇

pN+食管鳞状细胞癌患者R0切除术后放化疗与化疗的安全性及有效性比较

夏玲玲, 陈永顺(), 李彬, 宁婷婷, 张蔡羽天

  1. 武汉大学人民医院肿瘤四科,武汉 430060
  • 收稿日期:2022-03-25修回日期:2022-04-07出版日期:2022-06-08发布日期:2022-06-30
  • 通讯作者:陈永顺 E-mail:yongshun2007@163.com

Comparison of safety and efficacy between chemoradiotherapy and chemotherapy after R0 resection in pN+esophageal squamous cell carcinoma patients

Xia Lingling, Chen Yongshun(), Li Bin, Ning Tingting, Zhang Caiyutian

  1. Fourth Department of Oncology, Renmin Hospital of Wuhan University, Wuhan 430060, China
  • Received:2022-03-25Revised:2022-04-07Online:2022-06-08Published:2022-06-30
  • Contact:Chen Yongshun E-mail:yongshun2007@163.com

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摘要：目的探讨pN+食管鳞状细胞癌（ESCC）R0切除术后放化疗较化疗的安全性及有效性。方法回顾性分析99例2017年1月至2020年12月就诊于武汉大学人民医院行食管癌根治术的R0切除的pN+ESCC患者病理资料。依据术后辅助治疗方法分为放化疗组（n=41）和化疗组（n=58）。主要观察指标为无瘤生存期（DFS）、总生存期（OS）及治疗相关不良反应发生率。采用Kaplan-Meier法绘制生存曲线并行log-rank检验,采用Cox回归模型分析患者的预后影响因素。结果99例患者中位DFS和OS分别为20.0个月、28.0个月,1、3年DFS率分别为60.8%、34.5%,1、3年OS率分别为83.5%、40.2%。其中放化疗组和化疗组患者中位DFS分别为39.0个月、10.0个月,1、3年DFS率分别为79.4%vs.48.3%、57.3%vs.24.5%,差异具有统计学意义（χ2=12.27,P<0.001）;放化疗组中位OS未达到,化疗组为21.0个月,放化疗组和化疗组1、3年OS率分别为92.1%vs.75.9%、60.8%vs.27.3%,差异具有统计学意义（χ2=11.12,P=0.001）。单因素分析结果显示,pN分期（HR=0.58,95%CI为0.34~0.97,P=0.038）、神经侵犯（HR=1.88,95%CI为1.11~3.20,P=0.020）、辅助治疗方法（HR=0.37,95%CI为0.21~0.67,P˂0.001）均为pN+ESCC患者DFS的独立影响因素;辅助治疗方法（HR=0.33,95%CI为0.17~0.66,P=0.001）是pN+ESCC患者OS的独立影响因素。多因素分析结果显示,pN分期（HR=0.54,95%CI为0.30~0.97,P=0.038）和辅助治疗方法（HR=0.38,95%CI为0.21~0.69,P=0.001）均为患者DFS的独立预后因素;辅助治疗方法（HR=0.34,95%CI为0.17~0.69,P=0.003）为患者OS的独立预后因素。放化疗组和化疗组患者辅助治疗期间,白细胞减少[65.85%（27/41）vs.31.03%（18/58）,χ2=11.75,P=0.001]、血小板减少[29.27%（12/41）vs.10.34%（6/58）,χ2=5.78,P=0.016]、放射性食管炎[21.95%（9/41）vs.0（0/58）,χ2=11.48,P=0.001]、放射性肺炎[21.95%（9/41）vs.0（0/58）,χ2=11.48,P=0.001]发生率差异均具有统计学意义。结论放化疗较化疗可明显改善pN+ESCC R0切除患者DFS及OS,且不良反应可耐受。pN分期、辅助治疗方法均为患者DFS的独立预后因素,辅助治疗方法是患者OS的独立预后因素。

关键词:食管肿瘤,肿瘤, 鳞状细胞,化放疗

Abstract:ObjectiveTo investigate the safety and efficacy of chemoradiotherapy compared with chemotherapy after R0 excision in pN+esophageal squamous cell carcinoma （ESCC） patients.MethodsA retrospective analysis was performed on the pathological data of 99 pN+ESCC patients who underwent radical esophagectomy with R0 resection in Renmin Hospital of Wuhan University from January 2017 to December 2020. According to postoperative adjuvant treatment methods, the patients were divided into chemo-radiotherapy group （n=41） and chemotherapy group （n=58）. The main outcome measures were disease-free survival （DFS）, overall survival （OS） and the incidences of treatment-related adverse events. Kaplan-Meier method was used to draw the survival curve accompanied with log-rank test. Cox regression model was used to analyze the prognostic factors.ResultsThe median DFS and OS of 99 patients were 20.0 months and 28.0 months respectively. The 1- and 3-year DFS rates were 60.8% and 34.5% respectively. The 1- and 3-year OS rates were 83.5% and 40.2% respectively. The median DFS was 39.0 months in the chemoradiotherapy group and 10.0 months in the chemotherapy group, and the 1- and 3-year DFS rates were 79.4%vs.48.3% and 57.3%vs.24.5% respectively, with a statistically significant difference （χ2=12.27,P<0.001）. The median OS in the chemoradiotherapy group was not reached, and 21.0 months in the chemotherapy group, and the 1- and 3-year OS rates of the chemoradiotherapy group and chemotherapy group were 92.1%vs.75.9% and 60.8%vs.27.3%, with a statistically significant difference （χ2=11.12,P=0.001）. Univariate analysis showed that pN stage （HR=0.58, 95%CI： 0.34-0.97,P=0.038）, nerve invasion （HR=1.88, 95%CI： 1.11-3.20,P=0.020） and adjuvant therapy （HR=0.37, 95%CI： 0.21-0.67,P<0.001） were independent influencing factors of DFS in pN+ESCC patients. Adjuvant therapy （HR=0.33, 95%CI： 0.17-0.66,P=0.001） was an independent factor influencing OS in pN+ESCC patients. Multivariate analysis showed that pN stage （HR=0.54, 95%CI： 0.30-0.97,P=0.038） and adjuvant therapy （HR=0.38, 95%CI： 0.21-0.69,P=0.001） were independent prognostic factors of DFS. Adjuvant therapy （HR=0.34, 95%CI： 0.17-0.69,P=0.003） was an independent prognostic factor for OS. During adjuvant therapy, there were statistically significant differences in the incidences of leukopenia [65.85% （27/41）vs.31.03% （18/58）,χ2=11.75,P=0.001], thrombocytopenia [29.27% （12/41）vs.10.34% （6/58）,χ2=5.78,P=0.016], radioactive esophagitis [21.95% （9/41）vs.0 （0/58）,χ2=11.48,P=0.001], and radioactive pneumonia [21.95% （9/41）vs.0 （0/58）,χ2=11.48,P=0.001] between the two groups.ConclusionCompared with chemotherapy, chemoradiotherapy can significantly improve DFS and OS of pN+ESCC patients with R0 resection after radical surgery, and the adverse reactions can be tolerated. pN stage and adjuvant therapy are independent prognostic factors for DFS, and adjuvant therapy is an independent prognostic factor for OS.

Key words:Esophageal neoplasms,Neoplasms, squamous cell,Chemoradiotherapy