摘要目的:分析非手术治疗的胸段食管鳞状细胞癌(esophageal squamous cell carcinoma，ESCC)患者接受放化疗后首发血行转移的相关高危因素及其对生存预后的影响。方法:回顾性分析2011年1月至2018年10月在徐州医科大学附属滕州医院和徐州医科大学附属医院接受根治性放疗且符合入组标准的ESCC患者230例的临床资料。采用Logistic回归分析和生存分析方法分析患者治疗后血行转移的危险因素及生存预后。结果:230例胸段食管癌患者治疗后首次进展出现血行转移共70例(30.4%)，与未发生血行转移患者相比，中位总生存期分别为15个月与20个月(χ 2＝7.249， P＝0.007)，中位无进展生存期为9个月(95% CI 7.2～10.8个月)与13个月(95% CI 10.8～15.2个月)(χ 2＝21.664， P<0.001)。Logistic多因素分析结果显示，不同N分期出现血行转移差异有统计学意义(χ 2＝30.764， P<0.001)，N分期为判断血行转移的独立影响因素，N分期增加，发生血行转移风险增加( OR值分别为6.000、12.629、48.167；95% CI分别为1.712～21.025、3.546～44.976、10.848～213.858， P均<0.05)。血行转移前行同步放化疗患者较序贯放化疗及单纯放疗患者总生存期延长(χ 2＝10.002， P＝0.007)。全组分层分析提示N2、N3患者同步放化疗后辅助化疗，能延长患者总生存期(χ 2＝11.025， P＝0.001)。 结论:N分期为判断血行转移的独立影响因素；ESCC患者放化疗后出现血行转移预后差；N2、N3患者同步放化疗后辅助化疗有临床获益。

abstractsObjective:To analyze the risk factors of first-episode hematogenous metastasis in patients with thoracic esophageal squamous cell carcinoma (ESCC) who received non-surgical treatment after radiotherapy and chemotherapy, and its impact on survival and prognosis.Methods:The clinical data of 230 ESCC patients who met the inclusion criteria and received radical radiotherapy in Tengzhou Central People′s Hospital and Affiliated Hospital of Xuzhou Medical University from January 2011 to October 2018 were retrospectively analyzed.Logistic regression analysis and survival were used to analyze the risk factors and prognosis of blood group metastasis after treatment.Results:In 230 patients with thoracic esophageal cancer, 70 cases (30.4%) developed hematogenous metastasis for the first time.Compared with patients without hematogenous metastasis, the median overall survival was 15 months and 20 months (χ 2=7.249, P=0.007), and the median progression free survival was 9 months and 13 months (95% CI was 7.2-10.8 months and 10.8-15.2 months, respectively χ 2=21.664, P<0.001). Logistic multivariate analysis showed that there was significant difference in the occurrence of hematogenous metastasis among different N stages (χ 2=30.764, P<0.001). N stage was an independent factor for judging hematogenous metastasis, and the increased N stage increased the risk of hematogenous metastasis (OR value were 6.000, 12.629 and 48.167, respectively; 95% CI were 1.712-21.025, 3.546-44.976 and 10.848-213.858, respectively; all P<0.05). The overall survival time of patients with concurrent chemoradiotherapy before hematogenous metastasis was longer than that of patients with sequential chemoradiotherapy and radiotherapy alone (χ 2=10.002, P=0.007). Stratified analysis showed that adjuvant chemotherapy after concurrent chemoradiotherapy could prolong the overall survival of patients with N2 and N3 (χ 2=11.025, P=0.001). Conclusion:N staging is an independent factor to judge the hematogenous metastasis.ESCC patients with hematogenous metastasis after chemoradiotherapy have poor prognosis.N2, N3 patients with concurrent chemoradiotherapy after adjuvant chemotherapy have clinical benefits.