局部晚期食管鳞癌新辅助放化疗疗效的影响因素及预测

Analysis of clinical prognosis and influencing factors of pathological complete response in patients with locally advanced esophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy

目的探讨经新辅助放化疗(NCRT)的局部晚期食管鳞癌(ESCC)患者行根治性切除术后达到病理完全缓解(pCR)的影响因素,比较NCRT(40 Gy分20次)后达到pCR与否的两组ESCC患者的临床疗效及预后。方法在一项前瞻性临床试验所收集的患者中,选取2015年6月至2019年10月于天津医科大学肿瘤医院经NCRT后行根治切除术的87例ESCC患者。将上述患者分为术后pCR组(35例)和非pCR组(52例),回顾其临床病理特征并完善后期随访,运用Kaplan-Meier及Cox回归等方法对两组患者的生存预后及影响因素进行比较。结果经NCRT后,有40%的手术患者达到pCR。单因素分析显示,术后pCR组和非pCR组患者的无瘤生存(DFS)期(39.3∶14.1个月,P<0.01)、总生存(OS)期(64.0∶25.2个月,P<0.05)的差异均有统计学意义。多因素分析显示,术后pCR情况、患者的年龄分组、原发多病灶与否、放化疗后的疗效评价情况及术后病理结果均为影响患者生存预后的重要因素,两组差异均有统计学意义(P<0.05)。结论ESCC经NCRT后pCR状况和患者的生存预后密切相关,且术后pCR具有预测ESCC患者长期生存临床预后的重要价值。

Objective To investigate the influencing factors of pathologic complete response(pCR)after neoadjuvant chemoradiotherapy(NCRT)in patients with locally advanced esophageal squamous cell carcinoma(ESCC),and to compare the clinical prognosis of ESCC patients with and without pCR after NCRT(40 Gy/20F).Methods Among patients enrolled in a prospective clinical study,87 ESCC patients treated with NCRT followed by surgery in Tianjin Medical University Cancer Institute&Hospital between June 2015 and October 2019 were selected.They were divided into the pCR(n=35)and non-pCR groups(n=52).Clinicopathological characteristics were retrospectively analyzed and subsequent follow-up was performed.Clinical prognosis and influencing factors were compared between two groups by using Kaplan-Meier and Cox regression analyses.Results After NCRT,40%of the ESCC patients could achieve pCR.Univariate analysis showed that patients in the pCR group had a disease-free survival(DFS)of 39.3 months and an overall survival(OS)of 64.0 months.In comparison,patients in the non-pCR group had a DFS of only 14.1 months and an OS of only 25.2 months.The differences were statistically significant(DFS:P<0.01,OS:P<0.05).Multivariate analysis revealed that whether pCR or not after NCRT,age,number of primary lesions,evaluation results after NCRT and postoperative pathological outcomes were important prognostic factors.The differences were statistically significant between two groups(all P<0.05).Conclusion pCR after NCRT is significantly correlated with long-time survival of patients with ESCC,and pCR after NCRT has an important value in predicting clinical prognosis for long-term survival of ESCC patients.