食管鳞癌内镜黏膜下剥离术后T1b患者再治疗策略分析

doi:10.3969/j.issn.1674-8115.2024.01.013

上海交通大学学报（医学版） ›› 2024, Vol. 44 ›› Issue (1): 116-123.doi: 10.3969/j.issn.1674-8115.2024.01.013

• 论著 · 临床研究 • 上一篇

食管鳞癌内镜黏膜下剥离术后T1b患者再治疗策略分析

朱开元(), 苏瑜琛(), 刘智超, 章宏, 李春光, 张杰, 李志刚()

上海市胸科医院/上海交通大学医学院附属胸科医院胸外科，上海 200030

收稿日期:2023-09-04 接受日期:2024-01-02 出版日期:2024-01-28 发布日期:2024-02-28
通讯作者: 李志刚 E-mail:zhukaiyuan112@163.com;inalcohol@126.com;zhigang.li@shsmu.edu.cn
作者简介:朱开元（1999—），男，满族，博士生；电子信箱：zhukaiyuan112@163.com
苏瑜琛（1983—），男，主治医师，硕士；电子信箱：inalcohol@126.com第一联系人：（朱开元、苏瑜琛并列第一作者）
基金资助:
上海交通大学医学院“双百人”项目(20181816)

Adjuvant strategies for patients with T1b invasion after endoscopic submucosal dissection for esophageal squamous cell carcinoma

ZHU Kaiyuan(), SU Yuchen(), LIU Zhichao, ZHANG Hong, LI Chunguang, ZHANG Jie, LI Zhigang()

Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China

Received:2023-09-04 Accepted:2024-01-02 Online:2024-01-28 Published:2024-02-28
Contact: LI Zhigang E-mail:zhukaiyuan112@163.com;inalcohol@126.com;zhigang.li@shsmu.edu.cn
Supported by:
"Two-hundred Talents" Program of Shanghai Jiao Tong University School of Medicine(20181816)

摘要/Abstract

摘要：

目的·比较食管癌根治性切除术、同步放射和化学治疗与单纯随访观察3种策略对经内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）治疗后T1b浅表食管鳞癌患者预后的影响。方法·回顾性分析2016年5月—2021年5月于上海市胸科医院治疗的经ESD术后病理证实为pT1b期的67例食管鳞癌患者的临床资料。根据ESD术后追加的治疗方式分为追加手术组（S组）、放化疗组（CRT组）和观察组（O组）。采用χ²检验比较3组患者的临床基线资料和病理信息。采用Kaplan-Meier生存曲线和log-rank检验比较3组患者的无病生存期（disease free survival，DFS）和无复发生存期（recurrence free survival，RFS），并采用Cox比例风险回归模型对DFS和RFS进行单因素及多因素分析。结果·67例患者中，S组23例，CRT组19例，O组25例。3组组间年龄（P=0.080）、性别（P=0.078）、肿瘤大小（P=0.485）、食管癌临床分段（P=0.655）、环周累及（P=0.310）、分化程度（P=0.084）、浸润深度（P=0.066）、淋巴脉管侵犯（P=0.279）比较，差异均无统计学意义。经（42.6±16.7）个月的随访，共10例（14.9%）患者复发，其中6例（60%）为局部复发，2例（20%）为区域淋巴结转移，2例（20%）为远处转移；S组、CRT组、O组的中位复发时间分别为40.1、36.6、22.1个月，3年DFS分别为100%、89.5%和74.5%（P-trend=0.040）。多因素Cox分析显示，追加手术是改善RFS的独立保护性因素（HR=0.097，95%CI 0.010~0.956，P=0.046）。结论·对于浅表食管鳞癌ESD后证实为pT1b期的患者，追加手术可以显著减少远期复发可能。

关键词: 浅表食管癌, 食管鳞状细胞癌, 病理分期：内镜黏膜下剥离术, 追加治疗

Abstract:

Objective ·To compare the prognostic effects of radical resection of esophageal cancer, concurrent chemoradiotherapy and simple follow-up observation on the prognosis of patients with T1b invasion of superficial esophageal squamous cell carcinoma after endoscopic submucosal dissection (ESD). Methods ·From May 2016 to May 2021, the clinical data of 67 patients with esophageal squamous cell carcinoma who were pathologically confirmed as pT1b after ESD and treated in Shanghai Chest Hospital were retrospectively analyzed. According to the additional treatment after ESD, the patients were divided into additional surgery group (S group), chemoradio-therapy group (CRT group) and observation group (O group). χ² test was used to compare the clinical baseline data and pathological information of the three groups of patients. The Kaplan-Meier survival curve and log-rank test were used to compare the disease free survival (DFS) and recurrence free survival (RFS) of the three groups of patients, and the Cox proportional hazards regression model was used on DFS and RFS by univariate and multivariate analysis. Results ·Among all 67 patients, there were 23 cases in the S group, 19 cases in the CRT group, and 25 cases in the O group. There was no significant difference in age (P=0.080), gender (P=0.078), tumor length (P=0.485), tumor location (P=0.655), lesion circumferential ratio (P=0.310), histological grading (P=0.084), depth of tumor invasion (P=0.066) and lymphovascular invasion (P=0.279) among the three groups. During (42.6±16.7) months of follow-up, tumor recurrence was observed in 10 cases (14.9%), including 6 patients (60%) with local recurrence, 2 patients (20%) with regional lymph recurrence and 2 patients (20%) with distant metastasis. The median recurrence time of group S, group CRT, and group O was 40.1, 36.6, and 22.1 months, and the 3-year DFSs were 100%, 89.5%, and 74.5% (P-trend=0.040). Multivariate Cox analysis showed that additional esophagectomy was the key to improving independent protective factors of RFS (HR=0.097, 95%CI 0.010?0.956, P=0.046). Conclusion ·For patients with superficial esophageal squamous cell carcinoma confirmed as pT1b after ESD, additional surgery can significantly reduce the possibility of long-term recurrence.

Key words: superficial esophageal cancer, esophageal squamous cell carcinoma, pathology stage, endoscopic submucosal dissection, additional treatment

中图分类号:

R735.1

朱开元, 苏瑜琛, 刘智超, 章宏, 李春光, 张杰, 李志刚. 食管鳞癌内镜黏膜下剥离术后T1b患者再治疗策略分析[J]. 上海交通大学学报（医学版）, 2024, 44(1): 116-123.

ZHU Kaiyuan, SU Yuchen, LIU Zhichao, ZHANG Hong, LI Chunguang, ZHANG Jie, LI Zhigang. Adjuvant strategies for patients with T1b invasion after endoscopic submucosal dissection for esophageal squamous cell carcinoma[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(1): 116-123.

图/表 2

参考文献 35

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Characteristic	Total	S group	CRT group	O group	P value
Characteristic	(n=67)	(n=23)	(n=19)	(n=25)	P value
Age/years	65.3±7.4	63.1±4.9	64.4±5.5	68.1±9.5	0.080
Gender/n(%)					0.078
Male	54 (80.6)	22 (95.7)	14 (73.7)	18 (72.0)
Female	13 (19.4)	1 (4.3)	5 (26.3)	7 (28.0)
Smoking history/n(%)					0.213
None	22 (32.8)	5 (21.7)	6 (31.6)	11 (44.0)
Yes	39 (58.2)	17 (73.9)	10 (52.6)	12 (48.0)
Unknown^①	6 (9.0)	1 (4.3)	3 (15.8)	2 (8.0)
Alcohol history/n(%)					0.834
None	28 (41.8)	9 (39.1)	8 (42.1)	11 (44.0)
Yes	33 (49.2)	13 (56.5)	8 (42.1)	12 (48.0)
Unknown^①	6 (9.0)	1 (4.3)	3 (15.8)	2 (8.0)
Tumor length/cm	3.7±2.1	4.2±2.6	3.1±1.1	3.7±2.1	0.485
Tumor location/n(%)					0.655
Upper	6 (9.0)	2 (8.7)	3 (15.8)	1 (4.0)
Middle	26 (38.8)	9 (39.1)	8 (42.1)	9 (36.0)
Lower	35 (52.2)	12 (52.2)	8 (42.1)	15 (60.0)
Lesion circumferential ratio/n(%)					0.310
<0.50	20 (29.9)	5 (21.7)	8 (42.1)	7 (28.0)
≥0.50 and<0.75	31 (46.3)	13 (56.5)	9 (47.4)	9 (36.0)
≥0.75	12 (17.9)	5 (21.7)	1 (5.3)	6 (24.0)
Unknown^①	4 (6.0)	0 (0)	1 (5.3)	3 (12.0)
Histological grading/n(%)					0.084
G1	14 (20.9)	5 (21.7)	4 (21.1)	5 (20.0)
G2	29 (43.3)	5 (21.7)	9 (47.4)	15 (60.0)
G3	14 (20.9)	9 (39.1)	2 (10.5)	3 (12.0)
Gx	10 (14.9)	4 (17.4)	4 (21.1)	2 (8.0)
Pathology T stage after ESD/n(%)					0.066
pT1b-SM1	28 (41.8)	7 (30.4)	6 (31.6)	15 (60.0)
pT1b-SM2	39 (58.2)	16 (69.6)	13 (68.4)	10 (40.0)
Vertical margin/n(%)					0.075
Positive	18 (26.9)	9 (39.1)	6 (31.6)	3 (12)
Negative	48 (71.6)	13 (56.5)	13 (68.4)	22 (88)
Unknown^①	1 (1.5)	1 (4.3)	0 (0)	0 (0)
Horizontal margin/n(%)					0.814
Positive	21 (31.3)	6 (26.1)	6 (31.6)	9 (36.0)
Negative	45 (67.2)	16 (69.6)	13 (68.4)	16 (64.0)
Unknown^①	1 (1.5)	1 (4.3)	0 (0)	0 (0)
Lymphovascular invasion/n(%)					0.279
Positive	7 (10.4)	4 (17.4)	2 (10.5)	1 (4.0)
Negative	57 (85.1)	17 (73.9)	17 (89.5)	23 (92.0)
Unknown^①	3 (4.5)	2 (8.7)	0 (0)	1 (4.0)

Characteristic	Total	S group	CRT group	O group	P value
Characteristic	(n=67)	(n=23)	(n=19)	(n=25)	P value
Age/years	65.3±7.4	63.1±4.9	64.4±5.5	68.1±9.5	0.080
Gender/n(%)					0.078
Male	54 (80.6)	22 (95.7)	14 (73.7)	18 (72.0)
Female	13 (19.4)	1 (4.3)	5 (26.3)	7 (28.0)
Smoking history/n(%)					0.213
None	22 (32.8)	5 (21.7)	6 (31.6)	11 (44.0)
Yes	39 (58.2)	17 (73.9)	10 (52.6)	12 (48.0)
Unknown^①	6 (9.0)	1 (4.3)	3 (15.8)	2 (8.0)
Alcohol history/n(%)					0.834
None	28 (41.8)	9 (39.1)	8 (42.1)	11 (44.0)
Yes	33 (49.2)	13 (56.5)	8 (42.1)	12 (48.0)
Unknown^①	6 (9.0)	1 (4.3)	3 (15.8)	2 (8.0)
Tumor length/cm	3.7±2.1	4.2±2.6	3.1±1.1	3.7±2.1	0.485
Tumor location/n(%)					0.655
Upper	6 (9.0)	2 (8.7)	3 (15.8)	1 (4.0)
Middle	26 (38.8)	9 (39.1)	8 (42.1)	9 (36.0)
Lower	35 (52.2)	12 (52.2)	8 (42.1)	15 (60.0)
Lesion circumferential ratio/n(%)					0.310
<0.50	20 (29.9)	5 (21.7)	8 (42.1)	7 (28.0)
≥0.50 and<0.75	31 (46.3)	13 (56.5)	9 (47.4)	9 (36.0)
≥0.75	12 (17.9)	5 (21.7)	1 (5.3)	6 (24.0)
Unknown^①	4 (6.0)	0 (0)	1 (5.3)	3 (12.0)
Histological grading/n(%)					0.084
G1	14 (20.9)	5 (21.7)	4 (21.1)	5 (20.0)
G2	29 (43.3)	5 (21.7)	9 (47.4)	15 (60.0)
G3	14 (20.9)	9 (39.1)	2 (10.5)	3 (12.0)
Gx	10 (14.9)	4 (17.4)	4 (21.1)	2 (8.0)
Pathology T stage after ESD/n(%)					0.066
pT1b-SM1	28 (41.8)	7 (30.4)	6 (31.6)	15 (60.0)
pT1b-SM2	39 (58.2)	16 (69.6)	13 (68.4)	10 (40.0)
Vertical margin/n(%)					0.075
Positive	18 (26.9)	9 (39.1)	6 (31.6)	3 (12)
Negative	48 (71.6)	13 (56.5)	13 (68.4)	22 (88)
Unknown^①	1 (1.5)	1 (4.3)	0 (0)	0 (0)
Horizontal margin/n(%)					0.814
Positive	21 (31.3)	6 (26.1)	6 (31.6)	9 (36.0)
Negative	45 (67.2)	16 (69.6)	13 (68.4)	16 (64.0)
Unknown^①	1 (1.5)	1 (4.3)	0 (0)	0 (0)
Lymphovascular invasion/n(%)					0.279
Positive	7 (10.4)	4 (17.4)	2 (10.5)	1 (4.0)
Negative	57 (85.1)	17 (73.9)	17 (89.5)	23 (92.0)
Unknown^①	3 (4.5)	2 (8.7)	0 (0)	1 (4.0)

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食管鳞癌内镜黏膜下剥离术后T1b患者再治疗策略分析

Adjuvant strategies for patients with T1b invasion after endoscopic submucosal dissection for esophageal squamous cell carcinoma

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