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Risk Factors and Patterns of Abdominal Lymph Node Recurrence After Radical Surgery for Locally Advanced Thoracic Esophageal Squamous Cell Cancer.

局部晚期胸段食管鳞癌根治术后腹腔淋巴结复发的危险因素及模式。

  • 影响因子:2.42
  • DOI:10.2147/CMAR.S249810
  • 作者列表:"Wang Y","Ye D","Kang M","Zhu L","Pan S","Wang F
  • 发表时间:2020-05-27
Abstract

Background:We aimed to identify the suitable indication and delineate the target volume based on the pattern of abdominal lymph node recurrence (ALNR) after radical surgery for guiding postoperative radiotherapy in thoracic esophageal squamous cell cancer (TESCC). Methods:Clinical data of patients with locally advanced TESCC after radical surgery without perioperative anti-tumor therapies from June 2011 to June 2016 were reviewed. Logistic regression analysis was used to find out the high-risk factors of ALNR. The pattern of ALNR was analysed and a template CT in the Pinnacle treatment plan system was used to reconstruct the distribution of the sites of ALNR. Results:A total of 63 (19.57%) patients with 276 lymph nodes of ALNR were identified in 322 patients. Univariate logistic regression indicated that pathological tumor location, width of tumor, T stage, N stage, TNM stage, ratio of lymph node metastasis (LNM), vessel carcinoma embolus, cancerous node, LNM in the middle and lower mediastinum, LNM in the abdominal region, ratio of LNM in the abdominal region were risk factors of ALNR. Multivariate logistic regression analysis showed that only LNM in the abdominal region was an independent risk factor. The odds ratio was 7.449 (95% CI=2.552-22.297, P<0.001). Station 16a2, station 9, station 16b1, and station 8 were the major regions of ALNR. The recurrence rates were 10.56%, 9.63%, 7.14% and 5.28% in these stations, respectively. Conclusion:Positive pathological abdominal lymph nodes should be the major indication for abdominal irradiation in postoperative radiotherapy for locally advanced TESCC. We recommended that the target volume includes station 8, station 9, station 16a2 and station 16b1 and proposed a specific delineation of the clinical target volume based on the distribution of ALNR on template CT images.

摘要

背景: 我们旨在根据腹部淋巴结复发 (ALNR) 的模式确定合适的适应症并勾画目标体积胸段食管鳞状细胞癌 (TESCC) 根治术后指导术后放疗。 方法: 回顾 2011 年 6 月至 2016 年 6 月收治的局部晚期 TESCC 根治术后未进行围手术期抗肿瘤治疗患者的临床资料。采用 Logistic 回归分析找出 ALNR 的高危因素。分析 ALNR 的模式,并使用 Pinnacle 治疗计划系统中的模板 CT 重建 ALNR 位点的分布。 结果: 在 19.57% 例患者中,共有 63 例 (276) 患者发现了 ALNR 的 322 个淋巴结。单因素 logistic 回归分析显示肿瘤病理部位、肿瘤宽度、 T 分期、 N 分期、 TNM 分期、淋巴结转移率 (LNM) 、脉管癌栓、癌中下纵隔 LNM,腹部 LNM,腹部 LNM 比值是 ALNR 的危险因素。多因素 logistic 回归分析显示,仅腹部 LNM 是独立危险因素。比值比为 7.449 (95% CI = 2.552 ~ 22.297,P<0.001)。16a2 站、 9 站、 16b1 站和 8 站是 ALNR 的主要区域。复发率分别为 10.56% 、 9.63% 、 7.14% 和 5.28%。 结论: 病理阳性腹腔淋巴结应作为局部晚期 TESCC 术后放疗腹部放疗的主要指征。我们推荐靶体积包括 8 站、 9 站、 16a2 站和 16b1 站,并根据模板 CT 图像上 ALNR 的分布提出了临床靶体积的具体勾画。

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METHODS:PURPOSE:The purpose of this study was to compare the survival and toxicities in cervical esophageal squamous cell carcinoma (CESCC) treated by concurrent chemoradiothrapy with either three-dimensional conformal radiotherapy (3D-CRT) or intensity-modulated radiotherapy (IMRT) techniques. Materials and Methods:A total of 112 consecutive CESCC patients were retrospectively reviewed. 3D-CRT and IMRT groups had been analyzed by propensity score matching method, with sex, age, Karnofsky performance status, induction chemotherapy, and tumor stage well matched. The Kaplan-Meier method and Cox proportional hazards model were used for overall survival (OS) and progression-free survival (PFS). Toxicities were compared between two groups by Fisher exact test. RESULTS:With a median follow-up time of 34.9 months, the 3-year OS (p=0.927) and PFS (p=0.859) rate was 49.6% and 45.8% in 3D-CRT group, compared with 54.4% and 42.8% in IMRT group. The rates of grade ≥ 3 esophagitis, grade ≥ 2 pneumonitis, esophageal stricture, and hemorrhage were comparable between two groups, while the rate of tracheostomy dependence was much higher in IMRT group than 3D-CRT group (14.3% vs.1.8%, p=0.032). Radiotherapy technique (hazard ratio [HR], 0.09; 95% confidence interval [CI], 0.01 to 0.79) and pretreatment hoarseness (HR, 0.12; 95% CI 0.02 to 0.70) were independently prognostic of tracheostomy dependence. CONCLUSION:No survival benefits had been observed while comparing IMRT versus 3D-CRT in CESCC patients. IMRT with fraction dose escalation and pretreatment hoarseness were considered to be associated with a higher risk for tracheostomy dependence. Radiation dose escalation beyond 60 Gy should be taken into account carefully when using IMRT with hypofractionated regimen.

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影响因子:1.24
发表时间:2020-01-01
DOI:10.3892/etm.2019.8190
作者列表:["Shang L","Pei QS","Xu D","Liu JY","Liu J"]

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翻译标题与摘要 下载文献
影响因子:2.64
发表时间:2020-01-01
DOI:10.1007/s11605-019-04456-x
作者列表:["Campos VJ","Mazzini GS","Juchem JF","Gurski RR"]

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