pT3N0M0期胸段食管鳞癌术后辅助性治疗对预后影响的初步分析

Effect of postoperative adjuvant therapy on the prognosis of patients with stage PT3N0M0 thoracic esophageal squamous cell carcinoma： a preliminary analysis

目的探讨pT3N0M0期胸段食管鳞癌（TSCC）术后患者预后影响因素，同时比较不同治疗模式对预后影响。方法对2007--2010年间收治的480例pT3N0M0期TSCC术后患者进行回顾分析，分析其预后影响因素，同时比较不同治疗模式对预后影响。Kaplan—Meier法计算生存率，Cox模型多因素预后分析。结果全组患者随访满1、3、5年者分别为439、333、278例，1、3、5年OS和DFS分别为90．0％、68．7％、57．9％和82．3％、60．4％、52．3％，中位数分别为87个月（95％CI=74．7～99．4）和71．3个月（95％CI=55．1．87．5）。三组患者部分临床病理资料的构成比有差异，经倾向得分匹配法法配对后每组各55例患者且各组具有可比性（P均〉0．05），倾向得分匹配法配对后单纯手术、术后化疗、术后放化疗／放疗患者的1、3、5年0S和DFS差异均有统计学意义（P=0．000、0．006）；Cox多因素分析结果显示患者年龄、病变部位和治疗方式为影响患者OS和DFS的因素（P=0．029、0．004、0．000，P=0．009、0．003、0．002），另外病变长度为影响患者DFS的因素（P=0．003）。结论pT3N0M0期TSCC术后患者仍有较高的治疗失败率，术后放化疗或放疗可以改善pLN0M0期TSCC患者的预后．提高术后患者5年OS和DFS，但最终结论需要前瞻性大宗病例的进一步证实。

Objective To determine the prognostic factors in patients with stage pT3NoM0 thoracic esophageal squamous cell carcinoma （TSCC） after esophagectomy, and to compare the effects of different treatment modalities on the prognosis of patients. Methods A retrospective analysis was conducted on 480 patients with stage pT3NoM0 TSCC from 2007 to 2010 to determine the prognostic factors in the patients, and to compare the effects of different treatment modalities on their prognosis. Survival rate was calculated using the Kaplan-Meier estimator, and multivariate analysis of prognostic factors was performed using the Cox model. Results Of the 439, 333, and 278 patients who completed the 1-, 3-, and 5-year follow-up, respectively, the 1-, 3-, and 5-year overall survival （OS） rates were 90. 0%, 68. 7%, and 57. 9%（median 87 months, 95% confidence interval （CI = 74. 7-99.4） , respectively, and the 1-, 3-, and 5-year disease- free survival （DFS） rates were 82. 3%, 60. 4%, and 52. 3%（median 71.3 months, 95%C/=55.1-87. 5） , respectively. In order to account for the different constituent ratios of some clinical and pathological data between the three groups of patients, 55 patients in each group were matched using propensity score matching （PSM） （all P〉0. 05）. It was found that the post-PSM 1-,3-, and 5-year OS and DFS were significantly different between patients who received surgery only, postoperative chemotherapy （POCT）, and postoperative chemoradiotherapy/radiotherapy （ POCRT/RT ） （ P = 0. 000 and 0. 006, respectively ）. Multivariate Cox analysis showed that age, lesion location, and treatment modality were independent prognostic factors for OS and DFS （P=0. 029,0. 004,0. 000 and P=0. 009,0. 003,0. 002）, and the length of lesion was also an independent prognostic factor for DFS （ P = 0. 003）. Conclusions Although the rate of post-operative treatment failure is still high among patients with stage pT3N0M0 TSCC, POCRT/PORT can improve the prognosis and the 5-year OS and DFS of these patients. However, further large-sample prospective studies will be required to confirm these findings.