新辅助治疗后食管鳞状细胞癌患者术后6个月内复发分析

Analysis of early recurrence within 6 months in patients of esophageal squamous cell carcinoma after neoadjuvant therapy followed by surgery

目的探讨新辅助治疗后的食管鳞状细胞癌患者术后6个月内的复发状况及其影响因素。方法回顾性分析2018年1月至2020年4月在上海市胸科医院胸外科接受新辅助治疗联合外科手术且随访资料完整的187食管癌患者资料。男性160例,女性27例,年龄(63.0±7.1)岁(范围:43~76岁)。新辅助治疗方案包括新辅助放化疗(CROSS方案)118例,新辅助放化疗(非CROSS方案)26例,新辅助化疗27例,新辅助免疫加化疗16例。采用t检验、χ^(2)检验和秩和检验对术后6个月内复发相关的因素进行单因素分析,采用Logistic回归进行多因素分析。结果187例患者中,术后6个月内共有30例患者复发(16.0%),复发模式包括局部复发1例,区域性复发11例,血源性复发转移13例,合并复发转移5例。单因素分析结果显示,复发患者与未复发患者的新辅助治疗前肿瘤T分期、新辅助治疗后肿瘤退缩情况、病理环周切缘情况、病理T分期与病理N分期存在差异(P值均<0.05)。多因素分析结果显示,新辅助治疗前肿瘤T3~4期(OR=2.701,95%CI:1.161~6.329,P=0.021),病理N(+)期(OR=1.654,95%CI:1.045~2.591,P=0.032)是术后6个月内复发的独立预后因素。结论对于接受新辅助治疗前肿瘤外侵明显(T3期以上)且经新辅助治疗后仍存在阳性淋巴结的患者,应警惕术后早期复发的可能。

Objectives To examine the prognosis factors of recurrence of esophageal carcinoma within 6 months after neoadjuvant therapy followd by surgery.Methods The clinical data of 187 patients with esophageal squamous cell carcinoma who underwent neoadjuvant therapy followed by curative esophagectomy between January 2018 and April 2020 at Department of Thoracic Surgery,Shanghai Chest Hospital were analyzed retrospectively.There were 160 males and 27 females,aging(63.0±7.1)years(range:43 to 76 years).The t test,χ^(2) test and rank-sum test were used for univariate analysis of the prognosis factors for recurrence within 6 months postoperative,while the Logistic regression was used for multivariate analysis.Results There were 30 patients(16.0%)developed recurrence within 6 months after operation,including local recurrence in 1 case,regional recurrence in 11 cases,hematogenous recurrence in 13 cases,and combined recurrence in 5 cases.Univariate analysis suggested that there was a significant difference in T staging of tumor before neoadjuvant therapy(cT),tumor regression grade,circumferential resection margin,pathological T stage(ypT)and pathological N stage(ypN)between the recurrence patients and non-recurrence patients(all P<0.05).Logistic regression analysis suggested that the cT3-4(OR=2.701,95%CI:1.161 to 6.329,P=0.021)and ypN(+)(OR=1.654,95%CI:1.045 to 2.591,P=0.032)were the independent prognosis factors for recurrence within 6 months.Conclusion The combination of neoadjuvant therapy and surgery is not effective in reducing early postoperative recurrence in patients who have invaded the epineurium before treatment,and still have positive lymph nodes after neoadjuvant therapy.