Prognosis and failure patterns of esophageal squamous cell carcinoma patients undergoing selective lymph node irradiation

W. Shen, Hong-mei Gao, Jinrui Xu, Shu-guang Li, You-mei Li, Shuchai Zhu
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Abstract

Objective To investigate the prognosis and failure mode of patients with esophageal squamous cell carcinoma receiving selective lymph node irradiation (ENI). Methods A total of 179 eligible patients with esophageal squamous cell carcinoma were retrospectively analyzed. The prognostic value of tumor-related factors, the influencing factors of short-term curative effect and prognosis of patients, and the single and multi factor indexes of affecting the overall survival rate (OS), progression free survival rate (PFS) and recurrence of patients were analyzed.SPSS 19.0 software was used for statistical analysis. Results The 1, 3- and 5-year OS of the whole group were 77.1%, 40.1% and 26.0%, respectively, and 1-, 3- and 5-year PFS were 62.6%, 30.6%, and 20.3%, respectively. Multivariate analysis showed that hoarseness, cN stage, cTNM stage, GTV-transverse diameter (GTV-D) and GTV-volume/length (GTV-V/L) were independent factors affecting OS (P<0.05). The sonar, cTNM staging, and short-term efficacy were independent factors affecting PFS (P<0.05). Recurrence occurred in 75 patients (41.9%) in the whole group, and 61 patients (34.1%) had distant metastases. Among them, 9 patients (10.6%) had both recurrence and distant metastasis. Of the 75 patients with recurrence, 64(85.3%) had simple esophageal recurrence, 4(5.3%) had lymph node recurrence, and 7 (9.3%) had both. Recurrence occurred in 18 of the 63 patients who achieved CR after treatment. Only 2 patients had lymph node recurrence. Logistic multivariate analysis showed that the surrounding tissue/organ invasion, GTV-D and short-term were independent factors affecting the recurrence rate (P<0.05). Conclusions ENI is feasible in patients with esophageal squamous cell carcinoma, and the main mode of failure is esophageal recurrence. Pre-treatment sonar, larger GTV-D and GTV-V/L, more advanced clinical stage and poorer short-term efficacy are indicators of poor prognosis, while the peripheral tissue involvement, GTV-D and short-term efficacy are the independent factors that influence failure. Key words: Esophageal neoplasms/esophageal squamous cell carcinoma; Intensity modulated conformal radiotherapy; Elective nodal irradiation; Prognosis; Failure mode
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选择性淋巴结照射食管鳞状细胞癌患者的预后及失败模式
目的探讨选择性淋巴结照射(ENI)对食管鳞状细胞癌患者的预后及失败模式。方法对179例符合条件的食管鳞状细胞癌患者进行回顾性分析。分析肿瘤相关因素的预后价值、影响患者短期疗效和预后的因素,以及影响患者总生存率(OS)、无进展生存率(PFS)和复发的单因素和多因素指标。采用SPSS 19.0软件进行统计分析。结果全组1、3、5年OS分别为77.1%、40.1%、26.0%,1、3、5年PFS分别为62.6%、30.6%、20.3%。多因素分析显示,嗓音嘶哑、cN分期、cTNM分期、gtv -横径(GTV-D)、gtv -体积/长度(GTV-V/L)是影响OS的独立因素(P<0.05)。声纳、cTNM分期、短期疗效是影响PFS的独立因素(P<0.05)。全组复发75例(41.9%),远处转移61例(34.1%)。其中9例(10.6%)同时有复发和远处转移。75例复发患者中,单纯食管复发64例(85.3%),淋巴结复发4例(5.3%),两者兼有7例(9.3%)。治疗后达到CR的63例患者中有18例出现复发。仅有2例出现淋巴结复发。Logistic多因素分析显示,周围组织/器官侵犯、GTV-D、短期是影响复发率的独立因素(P<0.05)。结论食管鳞状细胞癌患者行ENI是可行的,失败的主要方式为食管复发。治疗前声纳、GTV-D、GTV-V/L较大、临床分期较晚、短期疗效较差是预后较差的指标,外周组织受累、GTV-D、短期疗效是影响失败的独立因素。关键词:食管肿瘤/食管鳞状细胞癌;调强适形放疗;选择性淋巴结照射;预后;失效模式
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中华放射医学与防护杂志
中华放射医学与防护杂志 Medicine-Radiology, Nuclear Medicine and Imaging
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