上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2017, Vol. 37 ›› Issue (10): 1407-.doi: 10.3969/j.issn.1674-8115.2017.10.020

• 论著（临床研究） • 上一篇    下一篇

淋巴结转移状态对局部晚期食管鳞癌术后患者放射治疗预后的影响

徐欣，马秀梅，周荻，白永瑞   

  1. 上海交通大学 医学院附属仁济医院放疗科，上海 200127
  • 出版日期:2017-10-28 发布日期:2017-11-01
  • 通讯作者: 白永瑞，电子信箱：baiyongruiz@163.com
  • 作者简介:徐欣（1984—），女，住院医师，硕士；电子信箱：xhsu1984@foxmail.com

Effects of the status of lymph nodes metastasis on the prognosis of postoperative radiotherapy for patients with locally advanced esophageal squamous cell carcinoma#br#

XU Xin, MA Xiu-mei, ZHOU Di, BAI Yong-rui   

  1. Department of Radiation Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2017-10-28 Published:2017-11-01

PDF (PC)

774

摘要： 目的 · 探讨局部晚期食管鳞癌术后患者放射治疗的预后因素，以及淋巴结转移状态对患者生存及治疗失败模式的影响。方 法 · 收集2006—2013 年接受肿瘤根治术后放射治疗的121 例局部晚期食管鳞癌患者资料，采用Kaplan-Meier 法计算无病生存时间 （DFS）和总生存时间（OS），分别利用 log-rank 法和 Cox 模型进行单因素和多因素预后分析，比较不同淋巴结转移状态患者 OS 及复 发模式的差异。结果 · 121 例患者的中位 DFS 为 22.57 个月，中位 OS 为 32.90 个月。多因素分析结果显示 KPS 评分、病变长度、阳 性淋巴结比例（pLNR）是 DFS 和 OS 的独立预后因素。对于淋巴结阳性的患者，pLNR ≤ 0.15 和 pLNR>0.15 患者的中位 OS 分别为 33.43 和 19.20 个月（P=0.04）；无淋巴结跳跃式转移（NSM）患者的中位OS 优于有NSM 患者，但差异无统计学意义；pLNR>0.15 且有 NSM 患者的 OS 显著差于其他淋巴结阳性的患者 ( 中位 OS :14.33 个月 vs 32.50 个月；P=0.02)；pLNR 较阳性淋巴结数对 OS 有更 好的预测价值（AUC=0.673, P=0.04）。治疗失败模式的分析结果显示：pLNR>0.15 患者中远处转移较局部复发多见，而 pLNR ≤ 0.15 患者中局部复发较远处转移多见。结论 · 淋巴结转移状态与食管癌术后患者放射治疗的预后相关。对于淋巴结阳性的患者，pLNR 对 OS 有更好的预测价值；不同 pLNR 患者放射治疗后复发模式存在差异，高 pLNR 且有 NSM 患者的预后较差。

关键词: 食管鳞癌, 术后放射治疗, 淋巴结转移, 预后

Abstract:

Objective · To explore the prognostic factors for postoperative radiotherapy for patients with locally advanced esophageal squamous cell carcinoma (ESCC) and the effects of lymph nodes metastasis status on the survival of patients and failure modes of treatment.  Methods · Data of 121 patients with locally advanced ESCC who underwent radical resection and postoperative radiotherapy from 2006 to 2013 were collected. The overall survival (OS) and disease-free survival (DFS) were calculated using Kaplan-Meier. Univariate analysis and multivariate analysis were performed to investigate prognostic factors with the log-rank test and the Cox regression model. The differences in OS and recurrence patterns between patients with different lymph node metastasis status were compared.  Results · The median DFS of all patients was 22.57 months and median OS was 32.90 months. Multivariate analysis showed that KPS score, length of lesion, and positive lymph nodes ratio (pLNR) were independent prognostic factors for DFS and OS. For patients with positive lymph nodes, the median DFS of patients with pLNR ≤ 0.15 and pLNR>0.15 were 33.43 and 19.20 months (P=0.04). Patients without nodal skip metastasis (NSM) had better median OS than patients with NSM, but the difference was not statistically significant. OS was significantly worse in patients with pLNR>0.15 and NSM than in other patients with positive lymph nodes (median OS of 14.33 vs 32.50 months, P=0.02). pLNR had a better prognostic value for OS than the number of positive lymph nodes (AUC=0.673, P=0.04). Analysis of the failure patterns showed that more distant metastases were observed in patients with pLNR>0.15, while more local and regional recurrences were observed in patients with pLNR ≤ 0. 15.   Conclusion · The status of lymph nodes metastasis is associated with the prognosis of postoperative radiotherapy for patients with locally advanced ESCC. pLNR has a better prognostic value for OS for patients with positive lymph nodes. The recurrence pattern varies in patients with different pLNR after postoperative radiotherapy. The patients with high pLNR and NSM have poor prognosis.

Key words: esophageal squamous cell carcinoma, postoperative radiotherapy, lymph node metastasis, prognosis