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Preoperative Chemoradiotherapy followed by Surgery in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma: A Single Center Experience in Southern Taiwan

局部晚期食道鱗狀上皮細胞癌病患接受術前化學放射治療合併手術:南台灣單一醫學中心的經驗

摘要


目的:局部晚期食道鱗狀上皮細胞癌病患的治療結果極差。近年來,術前化學放射治療合併手術常被用來試著改善此類病人預後,我們回溯高雄長庚醫院使用術前化學放射治療合併手術治療局部晚期食道鱗狀上皮細胞癌病患的臨床經驗並試圖找出可預測病人存活的臨床病理因子。方法:我們總共回溯了101位在高雄長庚診斷食道鱗狀上皮細胞癌病患並接受術前化學放射治療合併手術。單變量存活分析及多變量存活分析分別是使用對數等級檢定(log-rank test)及Cox比例風險模型。結果:在101位病人中,有26位(26%)達到病理完全反應,單變量存活分析顯示臨床T4分期及無法達到病理完全反應的病人有較差的整體存活率及無病存活率。三年整體存活率在臨床T1~3分期及臨床T4分期的病人分別是50%及24%(P = 0.01)。三年整體存活率在有達到病理完全反應的病人及無法達到病理完全反應的病人分別是68%及28%(P = 0.001)。多變量存活分析也發現臨床T4分期以及無法達到病理完全反應為較差的整體存活率及無病存活率的獨立預後因子。結論:臨床T4分期及無法達到病理完全反應明顯地與局部晚期食道鱗狀上皮細胞癌病患接受術前化學放射治療合併手術後較差的預後相關。

並列摘要


Objective: In general, the typical outcome of patients with locally advanced esophageal squamous cell carcinoma is poor. Recently, attempts have been made to improve survival of patients with esophageal cancer using preoperative chemoradiotherapy followed by surgery. The experience of a single center in Southern Taiwan with esophageal squamous cell carcinoma was reviewed to determine which clinicopathologic variables could predict survival. Methods: One hundred and one patients with diagnosed esophageal squamous cell carcinoma who were treated with preoperative chemoradiotherapy followed by surgery at Kaohsiung Chang Gung Memorial Hospital were retrospectively reviewed. Univariate and multivariate survival analyses were performed using log-rank and Cox proportional hazards models. Results: Of these 101 patients, 26% (26 of 101) achieved a pathologic complete response to treatment. Univariate analysis revealed that clinical T4 disease and absence of pathologic complete response were significantly associated with worse overall survival and disease-free survival. The 3-year overall survival rates were 50% and 24% in patients with clinical T1~3 and T4 disease, respectively (P = 0.01).The 3-year overall survival rates were 68% and 28% in patients with and without pathologic complete response, respectively (P = 0.001). Multivariate analysis also showed that clinical T4 disease and absence of pathologic complete response were independently associated with inferior overall and disease-free survival. Conclusions: Clinical T4 disease and absence of pathologic complete response were associated with significantly worse survival in patients with esophageal squamous cell carcinoma receiving preoperative chemoradiotherapy followed by surgery.

被引用紀錄


王郁臻、林玉茹、李美樺(2020)。照顧一位罹患食道癌病人接受食道重建手術之護理經驗腫瘤護理雜誌20(1),87-96。https://doi.org/10.6880%2fTJON.202006_20(1).07

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