T3～4期胸段食管鳞状细胞癌新辅助化疗联合免疫治疗后手术的复发模式及预后
The recurrence pattern and prognosis of stage T3-4 thoracic esophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy and surgery
张岩 1张国庆 1李向楠1
作者信息
- 1. 郑州大学第一附属医院胸外科,郑州 450000
- 折叠
摘要
目的 评估T3～4期胸段食管鳞状细胞癌患者经化疗联合免疫治疗后手术的肿瘤复发模式和预后.方法 纳入2020年1月至2023年8月在郑州大学第一附属医院接受联合治疗方案的329例患者,化疗方案为铂类药物联合紫杉醇,免疫治疗采用PD-1单克隆抗体,进行2～4个周期新辅助治疗后行McKeown食管癌根治术.登记患者的临床资料及随访数据,主要研究终点为总体生存率.次要研究终点为患者的疾病复发,按照复发模式分为局部复发和远处转移.计量资料使用独立样本t检验分析,计数资料采用卡方检验.生存率的比较使用Kaplan-Meier曲线以及Log-rank检验,预后相关危险因素采用Cox回归模型分析.结果 多因素分析显示治疗前T分期和治疗前N分期是影响患者预后的独立危险因素.整体队列3年OS率为76.1％,中位OS时间为43.6个月,生存分析进一步展示了不同T分期和N分期患者的生存差异,T4患者3年OS率、中位OS 时间低于 T3 患者(57.4％比 79.3％,x2=5.401,P＜0.05;30.6 个月 比 45.0 个月,t=2.188,P＜0.05).N2患者3年OS率及中位OS时间低于N0以及N1患者(47.8％比75.1％,x2=8.911,P＜0.05;47.8％比 82.6％,x2=7.777,P＜0.05、27.4 个月 比 30.0 个月,t=1.419,P＜0.05;27.4个月比45.2个月,t=2.411,P＜0.05).T4患者局部复发率高于T3患者(20.0％比9.7％,x2=5.043,P＜0.05),N+患者远处转移率高于 N0 患者(19.3％比 10.3％,x2=7.561,P＜0.05).结论 高T分期会导致患者局部复发率较高,N+会导致患者远处转移风险较高,这可能影响了患者的预后.
Abstract
Objective To evaluate the tumor recurrence pattern and prognosis of patients with T3-4 thoracic esophageal squamous cell carcinoma who underwent surgery after chemoradiotherapy.Methods Inclusion of 329 patients who received combined treatment from January 2020 to August 2023 at our hospi-tal,the chemotherapy regimen was a combination of platinum drugs and paclitaxel,and the immunotherapy used PD-1 monoclonal antibody,with 2-4 cycles of neoadjuvant treatment followed by McKeown esophagec-tomy for esophageal cancer.Collect the clinical data and follow-up data of the patients,and the primary re-search endpoint is overall survival rate.The secondary research endpoints are the recurrence of the disease and the recurrence pattern,which is divided into local recurrence and distant metastasis.The measurement data were analyzed by independent sample t-test,and the count data were analyzed by chi-square test.The comparison of survival rates was conducted using Kaplan-Meier curves and Log-rank test,and the prognos-tic related risk factors were analyzed using Cox regression model.Results Multivariate analysis showed that pretreatment T stage and pretreatment N stage were independent risk factors for patient prognosis.The overall cohort had a 3-year OS rate of 76.1％and a median OS of 43.6 months.Survival analysis further showed survival differences among patients with different T and N stages.The 3-year OS rate and median OS time of T4 patients were lower than those of T3 patients(57.4％vs.79.3％,x2=5.401,P＜0.05),(30.6 months vs.45.0 months,t=2.188,P＜0.05),suggesting that T4 has worse long-term prognosis.The 3-year OS rate and median OS time of N2 patients were lower than those of N0 and N1 patients(47.8％vs.75.1％,x2=8.911,P＜0.05;47.8％vs.82.6％,x2=7.777,P＜0.05;27.4 months vs.30.0 months,t=1.419,P＜0.05;27.4 months vs.45.2 months,t=2.411,P＜0.05),suggesting that N2 has worse long-term prognosis.The local recurrence rate of T4 patients was higher than that of T3 patients(20.0％vs.9.7％,x2=5.043,P＜0.05),and the distant metastasis rate of N+patients was higher than that of N0 patients(19.3％vs.10.3％,x2=7.561,P＜0.05).Conclusion A higher T stage leads to a higher local recurrence rate in patients,and N+leads to a higher risk of distant metastases in patients,which may affect patient prognosis.
关键词
食管鳞状细胞癌/复发模式/免疫治疗/预后Key words
Esophageal squamous cell carcinoma/Recurrence pattern/Immunotherapy/Prognosis引用本文复制引用
出版年
2024
NETL
NSTL
万方数据