临床无转移食管鳞癌肿瘤局部因素对治疗失败模式的影响

Association of local factors with treatment failure patterns in esophageal squamous cell carcinoma without clinical metastasis

目的分析临床无转移食管鳞癌（ESCC）患者肿瘤局部因素对区域性复发和远处转移的影响。方法对236例符合人组条件的ESCC患者进行回顾性分析，主要分析食管造影病变长度、肿瘤最大横径及肿瘤体积对患者生存及治疗失败模式的影响。Kaplan—Meier法计算0S等，Cox模型多因素分析。结果全组患者1、3、5年0S率，复发率及远处转移率分别为88．6％、52．4％、30．2％，15．5％、35：6％、45．8％及9．0％、22．2％、30．6％。多因素分析结果显示近期疗效、肿瘤最大横径为患者0s率的影响因素（P=0．000、0．019）；性别、肿瘤最大横径、照射方式、近期疗效为患者复发的影响因素（P=0．039、0．003、0．045、0．000）；肿瘤最大横径为患者远处转移的影响因素（P=0．035）。肿瘤最大横径为ENI及IFI组患者复发的影响因素（P=0．008、0．001）；病变造影长度、肿瘤最大横径、肿瘤体积为ENI组患者远处转移的影响因素（P=0．009、0．023、0．014）。结论临床无转移ESCC患者肿瘤局部因素对区域性复发和远处转移均有显著影响，其中肿瘤最大横径尤为重要。

Objective To investigate the association of local factors with local recurrence （LR） and distant metastasis （DM） in patients with esophageal squamous cell carcinoma （ESCC） who do not experience clinical metastasis. Methods A total of 236 eligible ESCC patients were analyzed retrospectively, and the association of lesion length on esophagography, maximum tumor diameter, and tumor volume with survival and treatment failure pattern was analyzed. Kaplan-Meier test and Cox regression were used for survival analysis and to identify prognostic factors. Results The 1-, 3-, and 5-year overall survival rates, LR rates, and DM rates were 88.6% ,52.4% ,30. 2%, 15.5% ,35.6% ,45.8%, and 9. 0% ,22. 2%, 30. 6%, respectively. The multivariate analysis showed that short-term treatment outcome and maximum tumor diameter were independent prognostic factors for overall survival rate （P= 0. 000, 0. 019）; sex, maximum tumor diameter, irradiation method, and short-term treatment outcome were independent prognostic factors for LR （P= 0. 039,0. 003,0. 045,0. 000） ;maximum tumor diameter was the independence factor for DM （P= O. 035）. In the patients receiving elective nodal irradiation and involved-field irradiation, the maximum tumor diameter was the prognostic factor for LR （ P= O. 008,0. 001 ） , and the lesion length on esophagography, maximum tumor diameter, and tumor volume were prognostic factors for DM （P= O. 009, 0. 023,0. 014）. Conclusions In ESCC patients without clinical metastasis, local factors are significantly associated with LR and DM, among which maximum tumor diameter is the most important factor.