| Song Chunyang,Zhu Shuchai,Su Jingwei,Li Juan,Shen Wenbin,Gao Sina,Zhao Yan,Xu Jinrui,Li Shuguang,Li Qiaofang.Patterns of recurrence after radical surgery and efficacy of salvage therapy after recurrence in patients with esophageal squamous cell carcinoma[J].Chinese Journal of Radiological Medicine and Protection,2020,40(11):840-845 |
| Patterns of recurrence after radical surgery and efficacy of salvage therapy after recurrence in patients with esophageal squamous cell carcinoma |
| Received:June 29, 2020 |
| DOI：10.3760/cma.j.issn.0254-5098.2020.11.005 |
| KeyWords:Esophageal neoplasm Radical surgery Post-recurrence survival Salvage therapy Prognosis |
| FundProject:2020-09-30 |
| Author Name | Affiliation | E-mail | | Song Chunyang | Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China | | | Zhu Shuchai | Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China | sczhu1965@163.com | | Su Jingwei | Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China | | | Li Juan | Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China | | | Shen Wenbin | Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China | | | Gao Sina | Department of Nephrology, Third Hospital of Shijiazhuang, Shijiazhuang 050011, China | | | Zhao Yan | Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China | | | Xu Jinrui | Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China | | | Li Shuguang | Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China | | | Li Qiaofang | Department of Oncology, Hebei Pepople's Hospital, Shijiazhuang 050011, China | |
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| Abstract:: |
| Objective To evaluate the recurrence patterns of esophageal squamous cell carcinoma (ESCC) after radical surgery and analyze the predictors of post-recurrence survival (PRS). Methods A total of 382 ESCC patients who developed recurrence after radical surgery were retrospectively reviewed from January 2007 to December 2011. All of them received salvage treatment after recurrence. The Univariate analysis was determined using the Kaplan-Meier method and log-rank test. Multivariate prognostic analysis was determined using the Cox proportional hazard model. Results The 1-, 3-, 5-year overall survival (OS) rates were 80.9%, 35.6% and 20.4%, respectively. The median survival time and recurrence time were 29.2 months and 15.0 months. The 1-, 3-, 5-year PRS rates were 37.7%, 14.6% and 11.9%, respectively. The median PRS time was 10.2 months. Locoregional recurrence was noted at 462 sites among 382 patients including 20.5% (95/462) of sites in supraclavicular LN (lymph node), 10.0% (46/462) in anastomosis, 56.1% (259/462) in mediastinal regional LN and 13.4% (62/462) in upper abdominal LN. There were 156, 43, 82 and 101 patients treated with salvage radiotherapy, chemotherapy, chemoradiotherapy and palliative care after recurrence, respectively. The univariate analysis showed that T stage, N stage, TNM stage, recurrence site, number of recurrent regions and treatment regimen after recurrence were significantly correlated with PRS (χ2=5.336, 4.292, 8.067, 7.482, 4.093, 76.426, P<0.05). Patients receiving salvage radiotherapy with the median dose of 60 Gy, were divided into <60 Gy group and ≥ 60 Gy group. The ≥60 Gy group had a better PRS than <60 Gy group (χ2=8.320,P<0.05). Multivariate analysis showed that number of recurrent regions and treatment regimen were independent prognostic factors of PRS. Conclusions Mediastinal and supraclavicular regions were the most common sites of recurrence in ESCC patients after radical surgery. Salvage radiotherapy and chemoradiotherapy could significantly improve PRS in recurrent ESCC patients. |
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