颈段食管癌放疗患者复发模式及生存分析

Patterns of failure and clinical outcomes of radiotherapy for cervical esophageal carcinoma

目的回顾分析初诊拟行根治性放疗颈段食管癌(CEC)患者的复发模式和生存结果。方法检索2008年8月至2017年5月初诊拟行根治性放疗的CEC患者,整理相关资料,总结临床特征和复发模式,并行生存分析。结果97例CEC患者符合条件,均为鳞癌。中位年龄59岁(18~78岁)。病变局限颈段34例,超出颈段63例。气管、甲状腺和主动脉受侵患者分别为69、7、6例。Ⅱ、Ⅲ和Ⅳ期(非区域淋巴结转移)患者分别为11、80、6例。中位大体肿瘤完成放疗剂量66Gy,46例≥66Gy,51例<66Gy。中位随访时间14.90个月,中位无进展生存(PFS)和总生存(OS)时间分别为16.03和23.30个月。1、2、3年PFS分别为56.86%、30.35%和26.34%。1、2、3年OS分别为72.54%、47.94%和40.81%。61例随访中发现治疗失败,其中40、27和18例分别发生局部复发、区域复发和远处转移。单因素分析显示,甲状腺受侵患者与无甲状腺受侵患者比较,PFS和OS差异有统计学意义(χ^2=5.773、13.461,P<0.05);气管受侵患者与无气管受侵患者比较,OS差异有统计学意义(χ^2=4.283,P<0.05)。多因素分析显示,主动脉受侵患者、甲状腺受侵患者与无主动脉受侵患者、无甲状腺受侵患者比较,PFS和OS差异有统计学意义(χ^2=6.796、4.548、13.421、10.581,P<0.05);大体肿瘤放疗剂量≥66Gy与大体肿瘤放疗剂量<66Gy比较,OS差异有统计学意义(χ^2=5.296,P<0.05)。结论根治性放疗颈段食管癌治疗失败以局部区域复发为主,甲状腺、气管和/或主动脉受侵是预后不良因素,大体肿瘤放疗剂量≥66Gy可能利于提高OS,但需前瞻大样本数据进一步证实。

Objective To review the failure patterns and clinical outcomes for patients with cervical esophageal carcinoma (CEC) undergoing definitive radiotherapy (RT). Methods Medical records, clinical characteristics and outcomes of patients with CEC treated by definitive RT from August 2008 to May 2017 were retrospectively reviewed and analyzed. Results A total of 97 patients with squamous cell CEC were enrolled in this study with a median age of 59 years old (range 18-78 years old). There were 34 patients with limited cervical esophagus, and 63 patients with diseases beyond cervical region, respectively. There were 69, 7, and 6 patients with Bronchi invasion, thyroid lobes involvement and aortic involvement, respectively. There were 11, 80 and 6 patients with stage Ⅱ, Ⅲ and Ⅳ (non-regional lymph node metastases), respectively. The median dose to the gross tumor volume (GTV) was 66 Gy, in which 46 patients received above 66 Gy and 51 patients received less than 66 Gy, respectively. The median progression free survival (PFS) and overall survival (OS) were 16.03 and 23.30 months, respectively, with a median follow-up of 14.90 months. The 1, 2, 3-year PFS and OS were 56.86%, 30.35%, 26.34%, and 72.54%, 47.94%, 40.81%, respectively. Sixty-one patients had treatment failure at their last follow-up, in which 40, 27, and 18 patients developed local failure, regional failure, and distant metastasis, respectively. Univariate analysis revealed that thyroid lobes involvement resulted in lower PFS (χ^2=5.773, P<0.05) and OS (χ^2=13.461, P<0.05), and bronchi involvement (χ^2=4.283, P<0.05) was associated with lower OS. Multivariate analysis indicated that aortic involvement and thyroid lobes involvement were associated with lower PFS (χ^2=6.796, 4.548, P<0.05) and OS (χ^2=13.421, 10.581, P<0.05), and GTV dose above 66 Gy was associated with higher OS (χ^2=5.296, P<0.05). Conclusions Local-regional recurrence was the main failure pattern for patients with CEC after definitive RT. Aortic, thyroid lobes, and/or bronchi involvement were associated with poor prognosis, and GTV dose ≥66 Gy tended to improve OS. Prospective studies with larger population were needed to further confirm this study.