Analysis of postoperative failure model in patients with stage pN0 esophageal squamous cell carcinoma and its effect on postoperative radiotherapy
10.3760/cma.j.issn.0254-5098.2017.03.007
- VernacularTitle:pN0期胸段食管鳞癌患者术后失败模式及其对术后放疗指导作用分析
- Author:
Wenbin SHEN
;
Hongmei GAO
;
Shuchai ZHU
;
Teng LI
;
Shuguang LI
;
Youmei LI
;
Zhikun LIU
;
Juan LI
;
Jingwei SU
- Keywords:
Esophageal neoplasms;
Prognosis;
Failure model
- From:
Chinese Journal of Radiological Medicine and Protection
2017;37(3):199-204
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the failure model of patients with stage pN0 thoracic esophageal squamous cell carcinoma (TESCC) after surgery alone and to discuss the feasibility of postoperative radiotherapy.Methods A retrospective analysis was performed on 473 patients with TESCC who received surgery alone from January 2007 to December 2010.The feasibility of adjuvant radiotherapy for pN0 TESCC patients was investigated through the failure model of postoperative patients.Results Of all patients,there were 57 cases with chest-regional recurrence (12.1％),most of which occurred in the mediastinal lymph nodes(52 case).There were 42 (8.9％) patients were identified as distant metastasis (DM),of which 13 cases were found to have both local recurrence and DM,and the total failure rate was 20.9％.The chest-regional recurrence rate of upper TESCC was statistically significantly higher than middle and lower (x2 =7.469,P ＜ 0.05),but DM rate had no statistically significant difference (P ＞ 0.05).The chest-regional recurrence rate and DM rate of the advanced T stage were significantly higher than those of the early T stage(x2 =10.247,7.886,P ＜ 0.05).The result of univariate analysis showed that disease site,the degree of adhesion,postoperative stump were significant factors of chestregional recurrence rate (x2 =14.232,9.486,7.546,P ＜ 0.05).Gender,smoking and preoperative weight loss ≥5 kg significantly influenced DM (x2 =10.823,10.275,6.065,P ＜ 0.05).In addition,the T stage was the significant influence factor of chest-regional recurrence and DM(x2 =15.994,12.885,P ＜0.05).The result of multivariate analysis showed that T stage and postoperative stump were independent factors of chest-regional recurrence (P ＜ 0.05).Smoking was an independent factor of DM (P ＜ 0.05).Conclusions There was a high rate of chest-regional recurrence in patients with stage pN0 TESCC who received surgery alone.Postoperative radiotherapy was recommended for patients with upper TESCC,advanced T stage,severe local adhesion,positive margin in and postoperative stump.Male,smoking and preoperative weight loss≥5 kg were associated with higher DM rate.
