食管癌辅助化疗期间并发症对预后的影响

Effect of complications on prognosis during neoadjuvant chemotherapy for esophageal cancer

目的探讨食管癌患者术后辅助化疗器件发生并发症对预后的影响。方法回顾分析2003—2011年南京鼓楼医院接受食管癌手术治疗并采用辅助化疗的738例患者的临床资料,并随访至2017年12月。采用多变量Cox比例风险模型分析辅助化疗期间发生血液系统和非血液系统并发症与短期和长期病死率之间的联系。结果在738例患者中,73例(9.9%)患者因辅助化疗产生并发症需要急诊住院治疗,血液系统并发症可导致术后90d病死率升高(HR=5.63,95%CI:1.26～24.81),在肿瘤分期为0～Ⅱ期的腺癌、无论切缘是否有残留的患者中尤为明显,食管腺癌术后5年疾病相关病死率显著升高(HR=3.21,95%CI:1.05～10.33)。在预计预后较差组(肿瘤分期Ⅲ～Ⅳ期)发生非血液系统并发症术后5年病死率较高(HR=2.34,95%CI:1.17～4.89)。其他亚组患者发生血液系统或非血液系统并发症并不影响5年病死率。结论食管癌患者接受食管切除术后行辅助化疗,发生相关并发症可能对患者近期及远期病死率产生不利影响。

Objective Previous researchers have focused upon the influence of postoperative complications on prognosis of esophagectomy, with very little attention paid to the potential negative effects of complications during neoadjuvant therapy. The hypothesis under investigation in this study was that the prognosis after esophageal cancer surgery is negatively influenced by complications causing hospital admission during neoadjuvant therapy.Methods Patients receiving neoadjuvant therapy and surgery for esophageal cancer between 2003 and 2011 were identified and followed up until 2017. The association between hematological and non-hematological complications during neoadjuvant therapy and risks of short-term and long-term mortality after surgery were analyzed using a multivariable Cox proportional hazards model, providing hazard ratios （HRs） with 95% confidence intervals （CIs）. The HRs were adjusted for appropriate confounding variables.Results Among 738 patients, complications during neoadjuvant therapy requiring emergency hospitalization affected 73 （ 9.9% ） patients. Hematological complications were associated with an increased 90-day overall mortality （ HR =5.63, 95% CI ： 1.26-24.81）, especially in patients with stage 0-Ⅱ regardless of whether there were residuals in incisal margins; and the disease-related mortality rate of esophageal adenocarcinoma was significantly increased after 5 years （ HR =3.21, 95% CI ： 1.05-10.33）. In the prognosis group of poor expectances （tumor stage Ⅲ-Ⅳ） with non-hematologic complications, there was a high mortality rate at 5 years after surgery （ HR =2.34, 95% CI ： 1.17-4.89）. Hematological or non-hematologic complications in other subgroups did not affect the 5-year mortality rate.Conclusions Adjuvant chemotherapy after esophagectomy for patients with esophageal cancer may cause complications which will adversely affect the short-term and long-term mortality.