术前放化疗合并腔镜手术近期疗效敏感的食管癌患者不同预后结局原因分析

Analysis of prognostic factors in esophageal cancer patients with satisfactory short-term outcome after neoadjuvant chemoradiotherapy followed by minimally invasive surgery

目的探讨术前放化疗合并腔镜手术近期疗效敏感的食管癌患者不同预后结局的原因。方法选取浙江省台州医院2011年6月—2014年6月术前放化疗合并腔镜手术治疗的符合纳入条件的中晚期食管癌患者21例。本组患者治疗前分期为ⅡB~ⅢA期,术前化疗采取NP方案静脉注射(长春瑞滨针25 mg/m^2,d_(1、8、22、29)及顺铂针25 mg/m^2,d_(1~4、22~25)),同期采用40 Gy/20 F常规分割放疗。放化疗后约7周施行胸腹腔镜联合下食管癌根治术。21例患者均为近期疗效敏感:原发灶病理缓解、腔镜手术实施顺利、术后无重大并发症发生并随访资料完整的病例。将年龄、性别、肿瘤位置、肿瘤长度、治疗前临床分期、术前放化疗方案完成情况、术前放化疗至手术时间、手术持续时间、术中出血量、清扫淋巴结区域及数目、阳性淋巴结病理情况、术后住院时间等相关因素进行多因素分析。结果 21例随访时间16~60个月,平均(44.6±12.6)个月,3、5年总的生存率分别为85.21%、73.85%。多因素分析结果表明年龄、术后病理淋巴结阳性是影响本组患者不同预后的独立因素(P<0.05)。结论术前放化疗并腔镜手术治疗局部中晚期食管癌是一种有效的治疗模式,尤其是对于近期疗效敏感的患者总体预后较好,但因为肿瘤异质性和个体差异性,加之年龄、淋巴结转移等众多因素可能造成预后结局不同。

Abstract：Objective To investigate the prognostic factor in esophageal cancer patients with satisfactory short-term outcome after neoadjuvant chemoradiotherapy followed by minimally invasive surgery（MIS）. Methods From June,2011 to June ,2014,21 case of locally advanced esophageal carcinoma undergoing neoadjuvant chemoradiotherapy followed by MIS and meeting the inclusion criteria were selected. According to EUS, CT and other examinations, all patients were divided into clinical stage Ⅱ A-Ⅲ B before the treatment. The first phase of treatment was concurrent chemoradiotherapy（ CRT）, NP has been adopted as a preoperative chemotherapy program（ vinorelbine 25 mg/m2 ,d1,8,22,29 and cisplatin 25 mg/m2, d l 4,22- 25 ）- During the same period, conventional fractionated radiotherapy with a dose of 40 Gy/20F was performed. Sev- en weeks after CRT, all patients received the treatment of subtotal resection of esophageal with a combined use of thoracos- copy and laparoscopy through right chest, abdomen and left cervical. Twenty-one cases of patients were of satisfactory re- cent efficacy：pathological remission in the primary tumor, smooth implementation of surgery, without postoperative major complications. Age, gender, tumor location, tumor size, clinical stage before the treatment, neoadjuvant chemoradiotherapy completion, the time interval between neoadjuvant chemoradiotherapy and MIS, operation duration, perioperative bleeding, the cleaned lymph node region and the number, positive lymph node pathology, hospital stay and other related factors have been multivariate analyzed. Results For 21 patients of satisfactory recent efficacy, the follow-up was 16 to 60 （44.6± 12.6） months, the 3-year and 5-year survival rates were 85.21% ,73.85%, respectively. The multivariate analysis showed the age,metastatic lymph nodes were the independent prognostic factors. Conclusion The regimen of neoadjuvant chemoradiotherapy followed by MIS in the treatment of locally advanced esophageal carcinoma is efficacy, especially for pa- tients with satisfactory short-term outcome. But the heterogeneity of tumor, individual differences, age, lymph node metastasis and other factors may affect the prognosis.