Treatment Outcomes and Prognostic Factors After Recurrence of Esophageal Squamous Cell carcinoma
Treatment Outcomes and Prognostic Factors After Recurrence of Esophageal Squamous Cell carcinoma
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DOI：
10.1007/s00268-017-4430-8
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发表时间：
2018-07-01
影响因子：
2.6
通讯作者：
Okada, Morihito
中科院分区：
文献类型：
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作者：
Hamai, Yoichi;Hihara, Jun;Okada, Morihito
通过对133例食管鳞癌根治性手术后复发患者的研究，分析了食管鳞癌的复发模式、治疗结果和预后因素，其中57例(42.9%)、54例(40.6%)和22例(16.5%)的复发分别为局部复发、远处复发和合并复发。所有患者的中位复发时间和中位生存期分别为9.1个月和8.3个月。单变量和多变量分析选择了复发时间(危险比[HR]，0.98；95%可信区间[CI]，0.97-0.999；p=0.04)，复发地点(局部区域与远距离：HR，1.63；95%CI，1.03-2.61；p=0.04)，复发器官数目(1对3：HR，3.49；95%CI，1.23-9.87；P=0.02)和复发后治疗(最佳支持治疗与化疗或放疗：HR，0.37；95%CI，0.15~0.94；P=0.04；BSC与CT和RT：HR，0.50；95%CI，0.26~0.94；P=0.03；BSC与手术：HR，0.47；95%CI，0.25~0.88；P=0.02)是影响复发后生存的独立因素。17例(12.8%)复发后接受多学科综合治疗的局部淋巴结复发和肺转移患者，术后生存3年。尽管ESCC患者存活率较低，且复发器官早期或远期复发或复发，但应针对复发的ESCC患者个体化设计合适的综合治疗方案。
The evaluation of treatment outcomes and detection of prognostic factors after recurrence are very important for tailoring optimal therapies for individual patients with recurrent esophageal cancer.We reviewed 133 patients in whom esophageal squamous cell carcinoma (ESCC) recurred after curative surgery, and assessed recurrence patterns, treatment outcomes and prognostic factors.Recurrence in 57 (42.9%), 54 (40.6%) and 22 (16.5%) patients was locoregional, distant and combined, respectively. The median amounts of elapsed time until recurrence and median survival after recurrence for all patients were 9.1 and 8.3 months, respectively. Univariate and multivariate analyses selected time to recurrence (hazard ratio [HR], 0.98; 95% confidence interval [CI], 0.97-0.999; p = 0.04), recurrence location (locoregional vs. distant: HR, 1.63; 95% CI, 1.03-2.61; p = 0.04), number of organs with recurrence (1 vs. 3: HR, 3.49; 95% CI, 1.23-9.87; p = 0.02) and treatment after recurrence (best supportive care, [BSC] vs. chemotherapy [CT] or radiation therapy [RT]: HR, 0.37; 95% CI, 0.15-0.94; p = 0.04; BSC vs. CT and RT: HR, 0.50; 95% CI, 0.26-0.94; p = 0.03; BSC vs. surgery: HR, 0.47; 95% CI, 0.25-0.88; p = 0.02) as independent factors for survival after recurrence. Seventeen (12.8%) patients who had localized lymph node recurrence and lung oligometastasis and received multidisciplinary therapy after recurrence survived for > 3 years thereafter.Despite the poor survival of patients with ESCC and early or distant recurrence or recurrence in recurrent organs, appropriate multimodal therapies should be tailored for individual patients with recurrent ESCC.