根治性放化疗后复发食管鳞癌的胶原表达及挽救治疗选择

Expression of collagen and salvage treatment for recurrent esophageal squamous cell carcinoma after radical chemoradiotherapy

目的探讨食管鳞癌根治性放化疗后局部复发病例的胶原纤维变化,以及不同挽救方式的不良反应和生存率差异,为挽救治疗方案的选择提供参考。方法回顾性收集2015年1月—2022年9月在武汉大学人民医院肿瘤中心接受根治性放化疗,并出现局部复发的137例食管鳞癌患者的病历资料。用Masson染色法测定不同复发时间病例的石蜡样本中胶原纤维表达,应用图像分析软件对胶原纤维的平均光密度值进行半定量分析。依据复发之后的挽救治疗方式,将患者分为挽救性手术组、二程放化疗组和免疫化疗组,分析三组患者生存率以及食管气管瘘、出血、心包积液、放射性肺炎、放射性食管炎等不良反应的发生率,用Kaplan-Meier法进行生存分析,log-rank检验分析组间生存率的差异。结果复发食管鳞癌中的胶原纤维表达量较原发食管鳞癌明显增高;胶原纤维表达随着复发时间的延长而逐渐减弱,7年后复发病例中的胶原纤维表达量和原发食管鳞癌类似。患者的1、2、3年生存率在挽救性手术组为47%、30%、20%,二程放化疗组为50%、27%、15%,免疫化疗组为72.5%、50%、50%,免疫化疗组患者的生存情况具有优于挽救性手术组和二程放化疗组的趋势,但差异无统计学意义。结论根治性放化疗后复发的食管鳞癌中富含胶原纤维,随着复发间隔时间延长,胶原纤维表达量减少;采用挽救性手术、二程放化疗和免疫化疗的挽救治疗方式效果相当。

Objective To investigate the change of collagen fibers in locally recurrent esophageal squamous cell carcinoma after radical chemoradiotherapy and the discrepancy of adverse effects and survival outcomes among groups with different salvage treatments,provide references for the options of salvage therapy.Methods Medical records of 137 patients with esophageal squamous cell carcinoma who received radical chemoradiotherapy and had local recurrence admitted to Cancer Center of Renmin Hospital of Wuhan University from January 2015 to September 2022 were retrospectively collected.The expression of collagen fibers in paraffin samples of cases with different recurrence time was determined by Masson staining,and the differences of the average optical density were calculated.According to the salvage treatment after local recurrence,all cases were divided into the salvage surgery group,second-course chemoradiotherapy group and immunochemotherapy group.The differences of survival outcomes and incidence rates of esophageal tracheal fistula,hemorrhage,pericardial effusion,radiation pneumonitis,radiation esophagitis were analyzed among the three groups.The differences of survival rates were analyzed by Kaplan-Meier method and compared by log-rank test among groups.Results The expression of collagen fibers in recurrent esophageal squamous cell carcinoma was significantly higher than that in primary esophageal squamous cell carcinoma.Collagen fiber expression was gradually down-regulated with the prolongation of recurrence time.The expression of collagen fibers in recurrent cases after 7 years was similar to that of primary esophageal squamous cell carcinoma.The 1-,2-and 3-year survival rates of patients in the salvage surgery group,the second-course chemoradiotherapy group and the immunochemotherapy group were 47%,30%,20%;50%,27%,15%and 72.5%,50%,50%,respectively;Immunochemotherapy was more effective in salvage treatment for recurrent esophageal squamous cell carcinoma,but there was no statistical difference.Conclusions Collagen fibers are abundant in recurrent esophageal squamous cell carcinoma after radical chemoradiotherapy.With prolongation of recurrent interval,the expression of collagen fibers is down-regulated.The survival outcomes of patients in the immunochemotherapy group,salvage surgery group and second-course chemoradiotherapy group were comparable.