病理T1N0食管鳞状细胞癌仅用手术治疗的复发及预后预测因子

Recurrence and prognostic predictors in pathologic T1N0 esophageal squamous cell carcinoma treated with surgery alone

SURGERY

影响因子:2.7

分区:医学2区 / 外科2区

发表日期:2025 Feb

作者: Manato Ohsawa, Yoichi Hamai, Manabu Emi, Yuta Ibuki, Tomoaki Kurokawa, Ryosuke Hirohata, Nao Kitasaki, Morihito Okada

DOI: 10.1016/j.surg.2024.09.019

摘要

诊断为病理T1N0食管鳞状细胞癌且仅接受手术治疗的患者预后良好，通常随访不进行辅助治疗。然而，仍观察到此类患者的复发情况。因此，本研究旨在识别接受仅手术治疗的病理T1N0食管鳞状细胞癌患者的复发和预后因素。在广岛大学医院于2003年8月至2018年11月期间接受食管切除术且R0切除的532例患者中，纳入124例仅接受食管切除术且诊断为T1N0的患者，分析其复发和预后因素，并评估复发的具体情况。五年无复发生存率和五年总生存率分别为84.7%和87.2%。在12例患者中观察到复发（9.7%）。单变量和多变量分析显示，组织学类型（分化不良优于其他类型）以及淋巴管和/或血管侵犯（阳性优于阴性）在无复发生存方面具有统计学意义。Kaplan-Meier曲线显示，这些因素显著区分了预后。所有具有分化不良和淋巴管/血管侵犯的患者均发生复发，且复发模式均为远处转移。分化不良和淋巴管/血管侵犯是仅用手术治疗的病理T1N0食管鳞状细胞癌的重要复发及预后预测因子。具有这些预后因素的患者复发率升高，且多伴有远处转移。因此，辅助治疗或许对这类患者有益，建议密切随访以早期发现复发。

Abstract

Patients diagnosed with pathologic T1N0 esophageal squamous cell carcinoma and treated with surgery alone have a good prognosis and are generally followed up without adjuvant therapy. However, recurrence has been observed in this patient group. Therefore, this study aimed to identify recurrence and prognostic factors in patients with pathologic T1N0 esophageal squamous cell carcinoma who were treated with surgery alone.Of the 532 patients who underwent esophagectomy with R0 resection at Hiroshima University Hospital between August 2003 and November 2018, 124 who underwent only esophagectomy and had pathological T1N0 esophageal squamous cell carcinoma were included in the study. Recurrence and prognostic factors were analyzed and details of recurrence were evaluated.The 5-year recurrence-free survival and 5-year overall survival rates were 84.7% and 87.2%, respectively. Recurrence was observed in 12 (9.7%) patients. Univariate and multivariate analyses showed that the histologic type (poorly differentiated compared with others) and lymphatic and/or vascular invasion (positive compared with negative) were statistically significant for recurrence-free survival. Kaplan-Meier curves for recurrence-free survival and overall survival showed that prognosis was significantly stratified according to these factors. All patients with poorly differentiated and positive lymphatic and/or vascular invasion experienced recurrence and recurrence pattern is all distant metastases.Poorly differentiated and lymphatic and/or vascular invasion are important recurrence and prognostic predictors in pathologic T1N0 esophageal squamous cell carcinoma treated with surgery alone. Patients with these prognostic factors experienced increased recurrence rates, often with distant metastasis. Therefore, adjuvant therapy may be beneficial for such patients and follow-ups should be performed at closer intervals.