CT Signs Can Predict Treatment Response and Long-Term Survival: A Study in Locally Advanced Esophageal Cancer with Preoperative Chemotherapy
CT Signs Can Predict Treatment Response and Long-Term Survival: A Study in Locally Advanced Esophageal Cancer with Preoperative Chemotherapy
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CT 征象可以预测治疗反应和长期生存：一项针对局部晚期食管癌术前化疗的研究
DOI：
10.1245/s10434-015-4531-2
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发表时间：
2015-12-01
影响因子：
3.7
通讯作者：
Chen, Ke-Neng
中科院分区：
文献类型：
--
作者：
Zhang, Xiao-Yan;Yan, Wan-Pu;Chen, Ke-Neng
背景在手术前准确预测治疗反应和预后可以及时调整治疗。本研究旨在评估计算机断层扫描（CT）征象在预测接受术前化疗的晚期食管鳞状细胞癌患者的治疗反应和生存率方面的有效性。本研究回顾性纳入了2005年9月至2011年12月期间接受术前化疗的135例连续患者。逻辑回归模型用于评估病理反应和CT征象之间的关联。采用Kaplan-Meier法估计总生存期（OS）和无病生存期（DFS），并构建考克斯比例风险模型以确定新辅助化疗后CT征象与生存结局之间的关系。逻辑回归显示，反应不良的重要预测因素是基线时淋巴结（LN）总数（>6）[比值比（OR）5.07; 95%置信区间（CI）1.86-13.81; P = 0.002]和CT值变化率（10 mm）[风险比（HR）2.33; 95%CI 1.36-4; P = 0.002），LN总数（>6）（HR 1.88; 95% CI 1.12-3.17; P = 0.017）和最大LN的短径（>10 mm）（HR 1.87; 95%CI 1.07-3.28; P = 0.028），而只有最大LN的短直径是DFS的重要预测因素（HR 2.36; 95% CI 1.23-4.54; P = 0.01）。CT征象可以预测治疗效果和生存结局，并提供手术前提供额外治疗选择的机会。
Background. Accurate prediction of treatment response and prognosis before surgery allows prompt therapy adjustment. This study aimed to evaluate the efficacy of computed tomography (CT) signs in predicting treatment response and survival for advanced esophageal squamous cell carcinoma patients who received preoperative chemotherapy.Methods. This study retrospectively enrolled 135 consecutive patients with preoperative chemotherapy from September 2005 to December 2011. A logistic regression model was used to evaluate the association between pathologic response and CT signs. Overall survival (OS) and disease/free survival (DFS) were estimated using the Kaplan-Meier method, and a Cox proportional hazards model was constructed to determine associations between CT signs after neoadjuvant chemotherapy and survival outcomes.Results. Logistic regression showed that the significant predictors of a poor response were the total number of lymph nodes (LNs) (>6) at baseline [odds ratio (OR) 5.07; 95 % confidence interval (CI) 1.86-13.81; P = 0.002] and the CT value change rate (10 mm) [hazard ratio (HR) 2.33; 95 % CI 1.36-4; P = 0.002), total number of LNs (>6) (HR 1.88; 95 % CI 1.12-3.17; P = 0.017), and short diameter of the largest LN (>10 mm) (HR 1.87; 95 % CI 1.07-3.28; P = 0.028), whereas only the short diameter of the largest LN was a significant predictor of DFS (HR 2.36; 95 % CI 1.23-4.54; P = 0.01).Conclusions. CT signs can predict therapeutic efficacy and survival outcomes and provide an opportunity to offer additional treatment options before surgery.