摘要目的 分析pT3N0M0期胸段食管鳞癌患者术后复发转移的挽救治疗效果和影响因素.方法 对2008年1月至2011年12月行手术治疗后复发转移的174例pT3N0M0期胸段食管鳞癌患者的临床资料进行回顾性分析,分析其复发转移部位、挽救治疗效果及其影响因素.结果 pT3N0M0期胸段食管鳞癌患者复发转移后1、3和5年总生存率分别为35.0%、19.3%和13.3%,中位生存时间7个月(95% CI 5.2~8.8).单因素分析结果显示,性别、年龄、复发转移部位、远处转移时间及挽救治疗与pT3N0M0期胸段食管鳞癌术后复发转移患者预后有关(P＜0.05或＜0.01),而体质量减轻(≥5 kg)、病变长度、病变部位、清扫淋巴结果数目、术后辅助治疗方法和胸腔内-复发时间与pT3N0M0期胸段食管鳞癌术后复发转移患者预后无关(P＞0.05).多因素分析结果显示,远处转移时间和挽救治疗是影响pT3N0M0期胸段食管鳞癌术后复发转移患者预后的独立危险因素(P＜0.01).结论 挽救治疗和远处转移时间是影响pT3N0M0期胸段食管鳞癌术后复发转移患者预后的独立危险因素,复发转移后放化疗或放疗可能在一定程度上延长患者的生存时间.

abstractsObjective To analyze the treatment effect and influencing factors of salvage therapy for postoperative recurrence and metastasis patients with pT3N0M0 stage thoracic esophageal squamous cell carcinoma. Methods The clinical data of 174 postoperative recurrence and metastasis patients with pT3N0M0 stage thoracic esophageal squamous cell carcinoma from January 2008 to December 2011 were retrospectively analyzed. The location of recurrence or metastasis, effect of salvage therapy and influencing factors were specifically focused. Results The 1-, 3-and 5-year overall survival rates after recurrence and metastasis in patients with pT3N0M0 stage thoracic esophageal squamous cell carcinoma were 35.0% , 19.3% and 13.3% respectively, and the median survival time was 7 months (95% CI 5.2 to 8.8). Single factor analysis results showed that the gender, age, location of recurrence or metastasis, distant metastasis time and salvage therapy were related to the prognosis in postoperative recurrence and metastasis patients with pT3N0M0 stage thoracic esophageal squamous carcinoma (P＜0.05 or＜0.01), but the weight loss (≥ 5 kg), lesion extent, lesion location, number of lymph node dissection, postoperative adjuvant treatment method and intrathoracic recurrence time were not related to the prognosis in postoperative recurrence and metastasis patients with pT3N0M0 stage thoracic esophageal squamous carcinoma (P＞0.05). Multivariate analysis result showed that the distant metastasis time and salvage therapy were the independent risk factors of prognosis in postoperative recurrence and metastasis patients with pT3N0M0 stage thoracic esophageal squamous carcinoma (P＜0.01). Conclusions Salvage therapy and distant metastasis time are independent risk factors of prognosis in postoperative recurrence and metastasis patients with pT3N0M0 stage thoracic esophageal squamous carcinoma, and chemoradiotherapy or radiotherapy after postoperative recurrence and metastasis in some extent could prolong the survival time.