Objective: To compare the outcome of postoperative adjuvant chemotherapy and surgery alone for stage pT1b-3N0M0 squamous cell carcinoma (SCC) of the thoracic esophagus. Methods: Two hundred and thirty-eight patients who underwent esophagectomy for stage pT1b-3N0M0 SCC of the thoracic esophagus in Department of Thoracic Surgery, Fourth Hospital, Hebei Medical University between January 2008 and February 2011 were analyzed retrospectively. These included postoperative adjuvant chemotherapy for 118 patients and surgery alone for 120 patients. In postoperative adjuvant chemotherapy arm, 3 or 4 cycles of taxol+ cisplatin (TP, n=33) or fluorouracil+ cisplatin (FP, n=85) regimens were given commencing from 4 to 6 weeks after surgery. Survival analysis was performed using Kaplan-Meier method. Univariate analysis for prognostic factors was performed by Log-rank test and multivariate by Cox regression model. Results: The 3- and 5-year disease-free survival (DFS) rates were 57.9% and 53.8%, respectively for postoperative adjuvant chemotherapy patients, compared to 40.4% and 32.5% for patients who underwent surgery alone (χ2=11.973, P=0.001). The 3- and 5-year overall survival (OS) rates were 64.4% and 55.9% in postoperative adjuvant chemotherapy patients, and 46.7% and 33.5% in surgery alone patients (χ2=13.110, P=0.000). Stratification analysis showed that there was significant difference in stage T3 patients (χ2=7.895, P=0.006), but not in stage T1b (χ2=0.762, P=0.383) and T2 (χ2=1.259, P=0.262) patients between adjuvant chemotherapy and surgery alone. Both DFS rate (χ2=1.748, P=0.186) and OS rate (χ2=2.200, P=0.138) of TP group were similar with FP group. Conclusion: In lymph node negative esophageal SCC patients, postoperative adjuvant chemotherapy shows survival benefits in stage T3 patients.
目的： 探讨辅助化疗能否改善pT1b～3N0M0期食管鳞状细胞癌患者的远期疗效。 方法： 回顾性分析2008年1月至2011年2月于河北医科大学第四医院胸外科接受食管鳞状细胞癌根治术的238例pT1b～3N0M0期患者的临床资料，按是否接受辅助化疗分为辅助化疗组118例，单纯手术组120例。辅助化疗组在术后4～6周开始进行3～4周期化疗，化疗方案包括氟尿嘧啶＋顺铂(FP)方案85例，紫杉醇＋顺铂(TP)方案33例。采用Kaplan－Meier法进行生存分析，单因素分析采用Log－rank检验，多因素分析采用Cox回归模型。 结果： 辅助化疗组患者3年、5年无病生存率分别为57.9%、53.8%，单纯手术组患者3年、5年无病生存率分别为40.4%、32.5%，两组无病生存曲线差异有统计学意义(χ2＝11.973，P＝0.001)。辅助化疗组患者3年、5年总体生存率分别为64.4%、55.9%，单纯手术组患者3年、5年总体生存率分别为46.7%、33.5%，两组总体生存曲线差异有统计学意义(χ2＝13.110，P＝0.000)。按T分期进行分层分析，T3期患者辅助化疗组总体生存率优于单纯手术组(χ2＝7.895，P＝0.005)，T1b期(χ2＝0.762, P＝0.383)和T2期(χ2＝1.259，P＝0.262)患者两组无差异。按化疗方案进行分层分析，TP方案组5年无病生存率(χ2＝1.748，P＝0.186)和总体生存率(χ2＝2.200，P＝0.138)与FP方案组相当。 结论： T分期较晚的pN0期食管癌患者可能从术后化疗中获益。.
Keywords: Antineoplastic combined chemotherapy protocols; Esophageal neoplasms; Prognosis.