摘要
目的探讨术后辅助化疗对于脉管癌栓阳性淋巴结无转移的食管鳞癌患者的意义,分析这些患者的生存及复发模式。方法收集2015年1月至2018年12月在我院行食管癌根治性切除术的患者资料。检索出食管鳞癌脉管癌栓阳性、淋巴结无转移的患者,根据患者是否接受术后辅助治疗,将患者分为术后辅助化疗组和单纯手术组。比较两组患者的化疗效果和随访资料。结果共纳入111例患者。60例患者在术后接受辅助化疗或放化疗,51例患者未接受术后辅助治疗。随访结束共有54例患者死亡。5年总生存率为51.4%。其中术后辅助化疗组的5年总生存率为58.3%,单纯手术组为43.1%,两组间总生存率差异无统计学意义。亚组分析显示,ⅡB期患者的5年总生存率,术后辅助化疗组优于单纯手术组(61.8%vs 30.4%,P=0.033)。ⅠB期(71.4%vs 57.1%)与ⅡA期(47.4%vs 52.4%)患者两组间的5年总生存率差异无统计学意义。单因素和多因素分析显示,肿瘤分化程度(P=0.010)是影响总生存率的独立危险因素。局部淋巴结复发和骨转移是这些患者的主要复发模式。结论术后病理脉管癌栓阳性而淋巴结无转移的ⅡB期食管鳞癌患者,可从术后辅助化疗中获益。肿瘤分化程度是影响总生存率的独立危险因素。脉管癌栓阳性的食管鳞癌患者术后更容易发生远处转移和局部淋巴结复发,术后复查不能忽视骨转移的排除。
Objective To explore the significance of postoperative adjuvant chemotherapy for esophageal squamous cell carcinoma patients with lymphovascular invasion(LVI)and without lymph node metastasis and analyze the recurrence pattern of these patients.Methods Data of patients who underwent radical resection of esophageal cancer in our hospital from Jan.2015 to Dec.2018 were collected.Patients with LVI and without lymph node metastasis were retrieved based on the pathological results.Patients were divided into the adjuvant chemotherapy group and none chemotherapy group according to the postoperative treatment strategy.The follow-up information of the two groups was compared.Results A total of 111 patients were enrolled,60 patients received postoperative adjuvant chemotherapy or chemoradiotherapy,51 patients did not receive postoperative treatment.Fifty-four patients had died.The 5-year overall survival rate was 51.4%.The 5-year overall survival rate was 58.3% in the adjuvant chemotherapy group and 43.1%in the none chemotherapy group.No significant difference in the overall survival rate was found between the two groups.Subgroup analysis showed that the 5-year overall survival rate of stage ⅡB patients was better in the adjuvant chemotherapy group than that in the none chemotherapy group(61.8%vs 30.4%,P=0.033).No significant difference in the 5-year overall survival rate was found between the adjuvant chemotherapy group and the none chemotherapy group for stage ⅠB(71.4%%vs 57.1%)and ⅡA(47.4%vs 52.4%)patients.Univariate and multivariate analysis showed that the tumor grade(P=0.010)was the independent risk factor affecting the overall survival.Local lymph node recurrence and bone metastasis were the main recurrence patterns in these patients.Conclusion Esophageal squamous cell carcinoma patients with LVI and negative lymph nodes can benefit from postoperative chemotherapy only if they are in stage ⅡB.Tumor grade is the independent risk factor for the overall survival.Patients with LVI are more likely to develop distant metastases and local lymph node recurrence post-surgery.
作者
李浩淼
巴玉峰
吕宏伟
于永魁
朱建平
刘奇
邢文群
LI Haomiao;BA Yufeng;LYU Hongwei;YU Yongkui;ZHU Jianping;LIU Qi;XING Wenqun(Department of Thoracic Surgery,the Affiliated Cancer Hospital of Zhengzhou University(Henan Cancer Hospital),Zhengzhou 450001,China)
出处
《胃肠病学和肝病学杂志》
2025年第9期1275-1281,共7页
Chinese Journal of Gastroenterology and Hepatology
基金
2023年河南省医学科技攻关计划项目(LHGJ20230103)。
关键词
食管鳞癌
脉管癌栓
术后辅助化疗
预后因素
术后复发
Esophageal squamous cell carcinoma
Lymphovascular invasion
Postoperative chemotherapy
Prognostic factor
Postoperative recurrence
