胸下段食管鳞状细胞癌弓上吻合根治术后辅助放射治疗的疗效分析

Efficacy of adjuvant radiotherapy for lower thoracic esophageal squamous cell carcinoma patients after radical operation with anastomosis above aortic arch

目的 分析胸下段食管鳞状细胞癌(鳞癌)行主动脉弓上吻合根治术后辅助放射治疗(放疗)的疗效及复发转移模式。方法 回顾性纳入2011年2月-2019年2月63例接受弓上吻合R0根治性术后辅助放疗的胸下段食管鳞癌患者,放疗靶区为吻合口、全纵隔及上腹部淋巴结引流区,分析其生存情况、肿瘤复发转移情况及各临床因素对生存的影响。结果 全组患者1、2、3年总生存率分别为98.3%、83.3%、63.7%;中位无病生存期为33个月[95%置信区间(23.2,42.8)个月],1、2、3年无病生存率分别为76.3%、58.5%、41.7%,N0~1期较N2~3期患者无病生存期更长(中位时间:中位时间未达到vs. 15个月,P=0.045);吻合口复发率7.9%,锁骨上区、中上纵隔及上腹部淋巴结引流区复发转移率分别为4.8%、15.9%、1.6%,远处转移率为17.5%;2~3级放射性肺炎发生率4.8%,3级吻合口狭窄发生率3.2%,3级气管瘘发生率1.6%。结论 N2~3期是该类患者辅助放疗后的预后不良因素,区域淋巴结复发主要集中于中上纵隔,放疗靶区是否需包含吻合口、下纵隔及上腹部淋巴结引流区值得商榷。

Objective To analyze the efficacy of and recurrence mode after adjuvant radiotherapy for lower thoracic esophageal squamous cell carcinoma(TESCC) patients after radical operation with anastomosis above aortic arch. Methods Sixty-three patients with lower TESCC who received adjuvant radiotherapy after R0 radical operation with anastomosis above aortic arch between February 2011 and February 2019 were retrospectively enrolled. The clinical tumor volume(CTV) included anastomotic stoma, and lymph node drainage area in mediastinum and upper abdomen.The survival status, recurrence and metastasis of tumors, and the influencing factors were analyzed. Results The 1-, 2-,and 3-year overall survival rates were 98.3%, 83.3%, and 63.7%, respectively. The median disease-free survival(DFS) was33 months [95% confidence interval(23.2, 42.8) months], and the 1-, 2-, and 3-year DFS rates were 76.3%, 58.5%, and41.7%, respectively. Patients with N0-1 had longer DFS than those with N2-3(median: not reached vs. 15 months,P=0.045). The recurrence rate of anastomotic site was 7.9%. The recurrence rates of lymph nodes in supraclavicular region, upper middle mediastinum, and upper abdomen were 4.8%, 15.9%, and 1.6%, respectively. The distant metastasis rate was 17.5%. The incidence of grade 2-3 radiation pneumonitis, grade 3 anastomotic stenosis, and grade 3 tracheal fistula were 4.8%, 3.2%, and 1.6%, respectively. Conclusions N2-3 is a poor prognostic factor for such patients. Regional lymph node recurrence is mainly revealed in the middle and upper mediastinum. Whether the CTV should include anastomotic stoma and lymph node drainage area in lower mediastinum and upper abdomen is questionable.