影响_PT₂N₀M₀期胸段食管鳞癌术后失败的COX多因素分析结果及其对术后辅助治疗的指导意义

Analysis of Postoperative Failure in Patients with Stage _PT₂N₀M₀ Esophageal Squamous Cell Carcinoma and Its Guiding Significance for Postoperative Adjuvant Therapy

摘要: 目的：分析_PT₂N₀M₀期胸段食管鳞癌术后患者的失败原因及其对术后辅助治疗的指导意义。方法：回顾性分析2007年1月至2010年12月在河北医科大学第四医院胸外科接受食管癌手术治疗的213例_PT₂N₀M₀期患者，分析其预后影响因素、失败原因等，应用SPSS19.0进行统计学分析，COX模型进行多因素分析。结果：全组出现胸腔内–区域复发54例(25.4%)，远处转移27例(12.7%)，胸腔内–区域复发合并远处转移患者15例。全组患者1、3、5年总生存率(OS)和无病生存率(DFS)分别为：93.9%、80.7%、71.7%和91.8%、77.3%、69.6%。COX多因素分析结果显示肿瘤组织分化程度为影响患者OS和DFS的独立性指标(P = 0.046、0.007)，另外病变部位也为影响患者DFS的独立性预后指标(P = 0.047)；食管病变部位为患者胸腔内–区域复发的独立性预后指标(P = 0.014)，肿瘤分化程度为影响远处转移的独立性预后指标(P = 0.021)。结论：即使接受了根治性手术切除的PT2N0M0期胸段食管鳞癌患者仍有较高的失败率，建议对于PT2N0M0期胸上段食管鳞癌和分化程度较低的患者应该积极予以术后辅助性治疗，最终结论需进行前瞻性研究证实。

Abstract: Objective: To analyze the causes of failure in PT2N0M0 thoracic esophageal squamous cell carcinoma postoperative patients and analyze the guiding significance of postoperative adjuvant radiotherapy. Methods: We retrospectively analyzed 213 patients with _PT₂N₀M₀ who underwent surgical treatment of esophageal cancer in our hospital from January 2007 to December 2010. The prognostic factors and failure reasons were analyzed. SPSS19.0 was used for statistical analysis, and COX model was used for multivariate analysis. Results: There were 54 cases (25.4%) with intrathoracic-regional recurrence in the whole group, 27 cases (12.7%) with distant metastases, and 15 cases with intrathoracic-regional recurrence and distant metastases. The overall survival (OS) and disease-free survival (DFS) of patients in the whole group were 93.9%, 80.7%, 71.7% and 91.8%, 77.3%, and 69.6%, respectively. Cox multivariate analysis showed that the degree of tumor differentiation was an independent index (P = 0.046, 0.007) that affected the OS and DFS of patients, and the location of lesions was also an independent prognostic index (P = 0.047); esophageal lesions were independent predictors of intrathoracic-regional recurrence (P = 0.014). The degree of tumor differentiation was an independent prognostic indicator of distant metastasis (P = 0.021). Conclusion: Even patients with _PT₂N₀M₀ thoracic esophageal squamous cell carcinoma undergoing radical resection have higher failure rate. It is recommended that postoperative adjuvant therapy should be actively performed for patients with _PT₂N₀M₀ upper thoracic esophageal squamous cell carcinoma and low differentiation. But, the final conclusion needs to be confirmed by forward-looking research.