局部晚期食管鳞癌术后恢复预期肿瘤治疗的特点及其与预后的关系

Characteristics of return to intended oncologic therapy and its relationship with prognosis in patients with locally advanced esophageal squamous cancer

目的描述局部晚期食管鳞癌术后恢复预期肿瘤治疗(return to intended oncologic therapy,RIOT)的特点,并调查其与总生存(overall survival,OS)的关系。方法回顾性分析2015年4月至2017年8月四川省肿瘤医院的600例行单纯根治性三切口(McKeown)或两切口(Ivor-Lewis)食管切除手术或食管切除手术加术后化疗的局部晚期食管鳞癌患者的临床资料。RIOT定义为RIOT比例(接受了预期的术后化疗患者的比例)和RIOT时间(手术至术后化疗开始的时间)。采用KaplanMeier法作生存曲线。采用log-rank检验比较术后接受或不接受化疗患者的OS。使用Cox回归模型评估是否进行RIOT和开始RIOT周数的预后。结果337例患者接受了手术加术后化疗,RIOT比例为56.2%。接受微创食管切除术患者和接受开放食管切除术患者的RIOT比例比较,差异无统计学意义[57.4%(232/404)vs 53.6%(105/196),P=0.37]。术后未接受化疗患者的死亡风险高于接受化疗的患者(HR=1.64,95%CI:1.22~2.21,P<0.01)。228例明确了术后化疗开始的日期,其中位RIOT时间为43 d。微创食管切除术和开放食管切除术患者的中位RIOT时间比较,差异无统计学意义(42 d vs 45 d,P=0.95)。RIOT时间每延迟1周,患者的死亡风险增加9%(HR=1.09,95%CI:1.02~1.15,P=0.01)。结论局部晚期食管鳞癌行微创手术和开放手术的RIOT无明显区别。更早的RIOT时间与更好的OS相关。

Objective To describe the characteristics of return to intended oncologic therapy(RIOT)in patients with locally advanced esophageal squamous cancer,and to investigate its relationship with overall survival(OS).Methods The clinical data of 600 patients with locally advanced esophageal squamous cancer who underwent radical three-incision(Mc Keown)or two-incision(Ivor-Lewis)esophagectomy alone or esophagectomy plus postoperative chemotherapy in Sichuan Cancer Hospital from April 2015 to August 2017 were retrospectively analyzed.RIOT was defined as the RIOT rate(proportion of patients who received the intended postoperative chemotherapy)and RIOT time(time from surgery to the start of postoperative chemotherapy).The Kaplan-Meier method was used to estimate OS,and the logrank test was used to compare OS in patients who received chemotherapy or not after surgery.Cox regression models were used to assess the prognosis of patients with or without RIOT and the number of weeks to start RIOT.Results Totally 337 patients underwent surgery plus postoperative chemotherapy,with a RIOT rate of 56.2%.The RIOT rates of patients with minimally invasive esophagectomy and with open esophagectomy were not statistically significantly different[57.4%(232/404)vs 53.6%(105/196),P<0.37].Patients who did not receive postoperative chemotherapy had a significantly higher risk of death than those who received chemotherapy(HR=1.64,95%CI:1.22-2.21,P<0.01).A total of 228 patients had confirmed starting dates of postoperative chemotherapy,with a median RIOT time of 43 days.The median RIOT time was not significantly different between patients with minimally invasive esophagectomy and those with open esophagectomy(42 d vs 45 d,P=0.95).Each 1-week delay in RIOT time was associated with a 9%increase in the risk of death(HR=1.09,95%CI:1.02-1.15;P=0.01).Conclusions There was no significant difference in RIOT between minimally invasive esophagectomy and open esophagectomy for locally advanced esophageal squamous cancer.Earlier RIOT time was independently associated with better OS.