食管鳞癌新辅助治疗联合手术的复发模式分析

Analysis of recurrence pattern of neoadjuvant therapy combined with surgical treatment for esophageal squamous cell carcinoma

目的分析食管鳞癌新辅助治疗联合手术的复发模式及其影响复发的风险因素。方法回顾分析2011-2015年间确诊的行新辅助治疗联合手术治疗及随访资料完整可分析的胸段食管鳞癌患者275例。分析新辅助联合手术治疗后复发的模式、复发时间、复发部位及影响复发的因素。Kaplan-Meier法计算复发率,Cox模型多因素分析。结果中位随访时间32个月(3~84个月),术后首次复发中位时间为10.6个月(2.0~69.1个月)。全组患者1、2、3年复发率分别为32.0%、45.1%、52.3%。全组共出现152例(55.3%)复发,其中77例(50.6%)为局部区域复发(LRR),34例(23.4%)为远处转移(DM),33例患者(21.7%)为LRR+DM,8例(6.0%)患者复发部位不详。LRR者中淋巴结复发最常见(98例,89.1%),DM者中肺转移(33例,49.3%)、肝转移(16例,23.9%)、骨转移(14例,20.9%)和非区域淋巴结转移(14例,20.9%)较常见。多因素分析显示术后T分期(P=0.008)、N分期(P<0.001)及清扫淋巴结数目(P<0.001)是影响疗后复发的危险因素。结论食管鳞癌新辅助治疗后仍有较高复发率,区域淋巴结为最常见复发部位。术后病理T、N分期及淋巴结清扫数目是影响疗后复发的危险因素。

Objective To evaluate the recurrence pattern and identify the risk factors of esophageal squamous cell carcinoma after neoadjuvant therapy combined with surgery.Methods Clinical data of 275 patients with thoracic esophageal squamous cell carcinoma treated with neoadjuvant therapy combined with surgery from December 2011 to December 2015 were retrospectively analyzed.The follow-up data of the enrolled patients were complete and analyzable.The recurrence pattern,recurrence time,recurrence location and influencing factors after neoadjuvant therapy in combination with surgery were analyzed.The recurrence rate was calculated by Kaplan-Meier method.The multivariate analysis was performed by Cox regression model.Results The median follow-up time was 32(3-84)months,and the median time of the first recurrence was 10.6(2.0-69.1)months.The 1-,2-and 3-year recurrence rates were 32.0%,45.1%and 52.3%,respectively.A total of 152 cases(55.3%)had recurrence.Among them,77 cases(50.6%)had local-regional recurrence(LRR),34 cases(23.4%)had distant metastasis(DM),33 cases(21.7%)had LRR+DM and 8 cases(6.0%)had recurrence in unknown site.Among the patients with LRR,lymph node recurrence was the most common(n=98,89.1%).For DM patients,lung metastasis(n=33,49.3%),liver metastasis(n=16,23.9%),bone metastasis(n=14,20.9%)and non-regional lymph node metastasis(n=14,20.9%)were commonly observed.The multivariate analysis showed that postoperative T stage(P=0.008),N stage(P<0.001)and the number of lymph node dissection(P<0.001)were the independent risk factors for recurrence after treatment.Conclusions The recurrence rate after neoadjuvant therapy remains relatively high for esophageal squamous cell carcinoma,and the regional lymph node is the most common site of recurrence.Postoperative pathological T staging,N staging and the number of lymph node dissection are the independent risk factors for recurrence after treatment.