食管癌根治术后复发患者122例预后因素分析

Analysis of prognostic factor in 122 patients with recurrent esophageal cancer after radical resection

目的探讨食管癌根治术后局部复发的疗效和预后影响因素。方法回顾性分析2008-01-31-2014-12-31河南省肿瘤医院收治的122例食管癌根治术后复发转移接受局部放疗患者资料,采用Kaplan-Meier法进行生存分析,组间比较采用Log-rank法,以Cox比例风险模型进行多因素分析。结果全组中位生存时间13个月,1~3年生存率分别为56.3%、26.2%和15.5%。单纯放疗者1~3年生存率分别为45.9%、9.8%和4.9%,放化疗患者1~3年生存率分别为62.2%、34.4%和22.9%,差异有统计学意义,χ^(2)=13.459,P=0.003。单因素分析显示,术后临床分期(χ^(2)=30.254,P=0.000)、放疗剂量(χ^(2)=7.464,P=0.038)、近期疗效(χ^(2)=13.299,P=0.003)、放化疗(χ^(2)=13.459,P=0.003)和术后复发时间(χ^(2)=6.560,P=0.035)是生存率的影响因素。多因素分析显示,术后临床分期(HR=0.289,95%CI:0.224~0.356,P=0.001)、放疗剂量(HR=2.525,95%CI:2.246~2.543,P=0.002)、联合化疗(HR=0.520,95%CI:0.465~0.594,P=0.004)是影响预后的独立危险因素。结论复发食管癌患者预后差,预后受多种因素影响,联合化疗、术后分期早、放疗总剂量54~<64Gy者预后相对较好。

Objective To study the efficacy of treatment and prognostic factors for recurrent esophageal cancer after radical esophagectomy.Methods The clinical data of 122 patients who were confirmed with recurrent metastatic esophageal cancer after radical resection and received radiotherapy in our hospital from 2008 to 2014 were retrospectively reviewed.Kaplan-Meier method was used to analyze the survival.Difference between groups was compared by Log-rank test,and Cox model was used for multivariate analysis.Results The medium survival was 13 months and the 1,2 and 3 years survial rates were 56.3%,26.2% and 15.5%.The 1,2 and 3 years survival rates were 45.9%,9.8%and 4.9%in radiationtherpy group,62.2%,34.4% and 22.9%in chemoradiotherpy group,and the difference was significant(χ^(2)=13.459,P=0.003).Univarriate analysis showed that the postoperative clinical stageing(χ^(2)=30.254,P<0.001),radiation dose(χ^(2)=7.464,P=0.038),short-term effects(χ^(2)=13.299,P=0.003),chemoradiotherpy(χ^(2)=13.459,P=0.003)and recurrence time(χ^(2)=6.560,P=0.035)were correlated with overall survival.Multivariate analysis indicated that the postoperative clinical stageing(HR=0.289,95%CI:0.224-0.356,P=0.001),radiation dose(HR=2.525,95%CI:2.246-2.543,P=0.002),chemoradiotherpy(HR=0.520,95%CI:0.465-0.594,P=0.004)were independent factors influencing prognosis.Conclusions The prognosis of patients with recurrent and metastatic esophageal cancer is poor,and it is affected by many factors.Chemoradiotherpy,early stage and radiation dose of 54-<64 Gy have better prognosis.