Risk Factors for Recurrence in Esophageal Squamous Cell Carcinoma Without Pathological Complete Response After Trimodal Therapy
Risk Factors for Recurrence in Esophageal Squamous Cell Carcinoma Without Pathological Complete Response After Trimodal Therapy
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DOI：
10.21873/anticanres.14442
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发表时间：
2020-08-01
影响因子：
2
通讯作者：
Okada, Morihito
中科院分区：
文献类型：
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作者：
Kurokawa, Tomoaki;Hamai, Yoichi;Okada, Morihito
背景/目的：局部晚期食管鳞状细胞癌（ESCC）需要强化三联疗法。对于切除的原发部位和/或淋巴结中有病理性残留肿瘤[非病理性完全缓解（pCR）]的患者，尤其需要预测复发，这些患者在三模式治疗后复发的可能性很高。我们的目的是确定三模式治疗后诊断为非pCR的ESCC患者癌症复发的风险因素。患者与方法：我们使用多变量考克斯比例风险分析评估了无复发生存期（RFS）的风险因素，该分析基于105例新辅助放化疗后食管切除术后诊断为非pCR的ESCC患者的数据。结果如下：单因素分析显示RFS与术后并发症、治疗后病理T、N、M分期（ypT、ypN、ypM）、肿瘤分化程度、淋巴管浸润（LVI）和原发肿瘤的病理反应显著相关。随后的多变量分析显示术后并发症ypN、肿瘤分化和LVI是RFS的独立变量。有无这些危险因素的患者之间的RFS显著不同。结论：严重的术后并发症、ypN 2/3、肿瘤分化差和LVI与RFS差显著相关。这些因素可作为三模式治疗后非pCR患者的预后因素。
Background/Aim: Intensive trimodal therapy is needed for locally advanced esophageal squamous cell carcinoma (ESCC). The prediction of recurrence is especially required for patients with pathological residual tumors in the resected primary sites and/or lymph nodes [non-pathological complete response (pCR)] who have a high possibility of recurrence after trimodal therapy. We aimed to determine the risk factors for cancer recurrence in ESCC patients diagnosed with non-pCR after trimodal therapy. Patients and Methods: We evaluated the risk factors for recurrence-free survival (RFS) using the multivariate Cox proportional hazards analysis, based on data from 105 ESCC patients diagnosed with non-pCR after neoadjuvant chemoradiotherapy followed by esophagectomy. Results: Univariate analysis revealed that RFS was significantly associated with postoperative complications, pathological T, N, M stage after therapy (ypT, ypN, ypM), tumor differentiation, lymphovascular invasion (LVI), and pathological response of the primary tumor. Subsequent multivariate analysis revealed postoperative complications ypN, tumor differentiation, and LVI as independent variables for RFS. The RFSs significantly differed between patients with and without these risk factors. Conclusion: Severe postoperative complications, ypN 2/3, poor tumor differentiation, and LVI were significantly associated with poor RFS. These factors may be used as prognostic factors in patients with non-pCR after trimodal therapy.