pT1-3N0M0期食管鳞癌二野术后复发和转移的因素分析

Analysis of risk factors of recurrence of pTi-3N0M0 esophageal squamous cell carcinoma after two-field esophagectomy

目的 回顾分析影响pT1-3N0M0期食管鳞癌术后复发和转移的因素。方法 收集胸段食管鳞癌行胸腹二野R0术后、病理分期为pT1-3N0M0期、手术前后未行辅助放疗和/或化疗、术后生存期≥3个月者 488例。Cox模型多因素分析。结果 至随访期结束总复发率为36.9%（180/488）,LRR率为21.5%（105/488）、DM率为6.8%（33/488）,LRR合并DM率为8.6%（42/488）。多因素分析显示肿瘤位置和pT分期是影响术后总复发、LRR和DM的因素;胸上段鳞癌和pT3期者复发率高,胸中段鳞癌和pT2期者次之,胸下段鳞癌和pT1期者复发率低。结论 肿瘤位置和pT分期是影响pT1-3N0M0期食管鳞癌二野R0术后复发和转移的重要因素,其结果有助于指导术后辅助放疗适应证选择。

Objective To retrospectively analyze the factors of postoperative recurrence of stage pT1-3N0M0 esophageal squamous cell carcinoma. Methods A total of 488 patients who underwent two-field R0 esophagectomy, pathologically classified as stage pT1-3N0M0, without adjuvant radiotherapy and/or chemotherapy before or after surgery and postoperative survival time≥ 3 months were enrolled in this study. Multivariate analysis was performed by using Cox model. Results At the end of follow-up, the overall recurrence rate was 36.9%（180/488）;the local recurrence rate was 21.5%（105/488）, the distant metastasis rate was 6.8%（33/488） and the local recurrence rate complicated with the distant metastasis rate was 8.6%（42/488）.Cox multivariate analysis demonstrated that tumor site and pT staging were the factors affecting the overall/local recurrence rate and distant metastasis. The recurrence rate in patients with the upper esophageal squamous cell carcinoma and stage pT3 was the highest, followed by those with the middle esophageal squamous cell carcinoma or stage pT2 and the lowest recurrence rate was observed in patients with the lower esophageal squamous cell carcinoma or stage pT1. Conclusions Tumor site and pT staging are the pivotal factors for postoperative recurrence of stage pT1-3N0M0 esophageal squamous cell carcinoma after two-field R0 esophagectomy, which contributes to offer guidance to the selection of indications for postoperative adjuvant radiotherapy.