706例胸段食管癌患者术后无进展生存状况分析

Analysis of Post-Esophagectomy Progression Free Survival in 706 Patients with Thoracic Esophageal Carcinoma

摘要: 目的：研究真实世界中胸段食管癌的复发特点及患者对辅助治疗的反应。方法：回顾性收集我院2008年1月至2015年12月就诊的食管癌术后复发患者，分析患者TNM分期、病理类型、淋巴结转移及辅助治疗对术后无进展生存的影响。结果：706例患者中鳞癌所占比例为93.06%，1年、3年、5年术后无进展生存率为52.1%、14.4%、5.2%，1年、3年、5年总生存率为63.9%、39.9%、14.9%。不同病理类型患者的中位术后无进展生存时间，鳞癌患者为13个月，腺癌14.5个月，小细胞癌12个月，其它14个月，各组间无统计学差异。657例鳞癌患者中，不同pTNM分期患者的术后无进展生存时间为3.41~26.4个月，3年术后无进展生存率为4.21%~44.5%，5年术后无进展生存率为0%~26.7%，术后无进展生存趋势与pTNM分期呈负相关。I期至IIb期患者接受辅助化疗对术后无进展生存期影响不明显(I-IIa期，p = 0.81；IIb期，p = 0.61)；III~IV期患者接受辅助化疗可提供术后无进展生存时间(IIIa期，p = 0.0009；IIIb期，p = 0.00001；IIIc-IV期，p = 0.047)，差异有统计学意义。结论：胸部食管癌术后不同分期患者的术后无进展生存特点不同、术后辅助化疗的结果也不同。我们的数据显示，早期食管癌微转移、精准判断术后辅助治疗的获益人群及发现新的有效辅助治疗手段应该成为食管癌诊治的研究热点。

Abstract: Objective: To study the characteristics of post-operative recurrence and the adjuvant therapy response of patients with thoracic esophageal carcinoma in the real world. Methods: Patients with recurrent of esophageal cancer were retrospectively collected from January 2008 to December 2015 in our hospital. The influence of pathological TNM stage, pathological type, lymph node metastasis and adjuvant treatment on progression free survival (PFS) was analyzed. Results: Of the 706 patients eligible for this study, 657 (93.06%) patients as esophageal squamous cell carcinoma (ESCC), the 1-, 3- and 5-year PFS rate were 52.1%, 14.4% and 5.2%, and the 1-, 3- and 5-year overall survival rate were 63.9%, 39.9% and 14.9%. The median postoperative progression free survival time has no significant difference in patients with different pathological types (13 months/ ESCC, 14.5 months/adenocarcinoma, 12 months/small cell carcinoma, 14 months/others). With different pathological TNM stages of ESCC patients, the time of PFS were 3.41 - 26.4 months, 3-year PFS rate was 4.21% - 44.5%, 5-year PFS rate was 0% - 26.7%. Adjuvant chemotherapy was significantly improved median PFS time in III stage patients with ESCC (IIIa, p = 0.0009; IIIb, p = 0.00001; IIIc, p = 0.047), but not in patients with I - II stages. Conclusion: The characteristics of PFS are different in patients with different stages of thoracic esophageal cancer, and the outcome of postoperative adjuvant chemotherapy are different too. From our data, micrometastasis of early esophageal cancer, accurate judgment of the beneficiaries of adjuvant therapy and discovery of new therapy should be the clinical research focus of esophageal cancer.