Ⅱ/Ⅲ期食管癌术前放化疗的影像学评价对预后的影响

Predictive value of imaging evaluation in stage Ⅱ/Ⅲ esophageal carcinoma patients treated with preoperative chemoradiotherapy

目的 回顾性分析Ⅱ/Ⅲ期食管癌术前放化疗后影像学评价对预后的影响.方法 对有完整随访资料的145例Ⅱ/Ⅲ期食管癌术前放化疗患者进行回顾性分析.分析内容包括术后病理完全缓解（pCR）与未达完全缓解（NpCR）、X射线造影完全缓解（xCR）与未完全缓解（NxCR）及实体瘤疗效评价标准（RECIST）完全缓解（rCR）与未完全缓解（NrCR）的总生存率,并进行多因素分析.结果 全部145例患者,pCR率33.8％,xCR率42.8％,rCR率38.6％.pCR患者与NpCR患者1、3、5年总生存率分别为87.8％、79.6％、61.2％与75％、40.6％、24.0％,差异有统计学意义（χ^2=20.215,P＜0.05）;xCR患者与NxCR患者1、3、5年总生存率分别为80.6％、66.1％、51.6％与75％、44.6％、25.3％,差异有统计学意义（χ^2=8.895,P＜0.05）;rCR患者与NrCR患者1、3、5年总生存率分别为83.9％、69.6％、53.6％与76.4％、46.1％、25.8％,差异有统计学意义（χ^2=10.862,P ＜0.05）,Cox模型进行多因素分析显示pCR是独立预后因素（HR=0.333,95％ CI：0.200 ～0.554,P ＜0.05）.结论 xCR、rCR较NxCR、NrCR明显提高了生存率,可以指导临床进行疗效判断;pCR为独立预后因素,术后pCR依然是食管癌术前同步放化疗疗效判断的金标准.

Objective Retrospectively analyzed the predictive value of imaging evaluation in stage Ⅱ/Ⅲ esophageal carcinoma patients treated with preoperative chemoradiotherapy.Methods A total of 145 stage Ⅱ/Ⅲ esophageal carcinoma pantients were enrolled.We analyzed the overall survival rates of the patients with pathological complete response （pCR） and those without （NpCR）,X-film complete response （xCR） and those without （NxCR）,RECIST complete response （rCR） and those without （NrCR）.And we used Cox model for multivariate analysis.Results The rates of pCR,xCR and rCR were 33.8%,42.8% and 38.6% for all patients,respectively.The 1-,3-5-year overall survival rates were 87.8%,79.6%,61.2% for pCR patients and 75%,40.6%,24.0% for NpCR patients （χ^2 =20.215,P 〈0.05）,respectively;The 1-,3-5-year overall survival rates were 80.6%,66.1%,51.6% for xCR patients and 75%,44.6%,25.3% for NxCR patients（χ^2 =8.895,P 〈0.05）,respectively;The 1-,3-5-year overall survival rates were 83.9%,69.6%,53.6% for rCR patients and 76.4%,46.1%,25.8% for NxCR patients（χ^2 =10.862,P 〈 0.05）,respectively.Multivariate survival analysis using Cox regression model showed that pCR was a positive independent prognostic factor （HR =0.333,95% CI：0.200-0.554,P 〈 0.05）.Conclusions Short-term imaging evaluation could effectively predict the prognosis of stage Ⅱ/Ⅲ esophageal carcinoma patients treated with preoperative chemoradiotherapy.And pCR was a positive independent prognostic factor.