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中华胸部外科电子杂志 ›› 2018, Vol. 05 ›› Issue (03) : 153 -158. doi: 10.3877/cma.j.issn.2095-8773.2018.03.03

所属专题: 文献

论著

食管癌辅助化疗期间并发症对预后的影响
史敏科1, 宣煜龙1,(), 陈保俊1, 曹彬1   
  1. 1. 210008 南京大学医学院附属南京鼓楼医院心胸外科
  • 收稿日期:2018-03-30 出版日期:2018-08-28
  • 通信作者: 宣煜龙

Effect of complications on prognosis during neoadjuvant chemotherapy for esophageal cancer

Minke Shi1, Yulong Xuan1,(), Baojun Chen1, Bin Cao1   

  1. 1. Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital the Affiliated of Nanjing University Medical School, Nanjing 210008, China
  • Received:2018-03-30 Published:2018-08-28
  • Corresponding author: Yulong Xuan
  • About author:
    Corresponding author: Xuan Yulong, Email:
引用本文:

史敏科, 宣煜龙, 陈保俊, 曹彬. 食管癌辅助化疗期间并发症对预后的影响[J/OL]. 中华胸部外科电子杂志, 2018, 05(03): 153-158.

Minke Shi, Yulong Xuan, Baojun Chen, Bin Cao. Effect of complications on prognosis during neoadjuvant chemotherapy for esophageal cancer[J/OL]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2018, 05(03): 153-158.

目的

探讨食管癌患者术后辅助化疗器件发生并发症对预后的影响。

方法

回顾分析2003—2011年南京鼓楼医院接受食管癌手术治疗并采用辅助化疗的738例患者的临床资料,并随访至2017年12月。采用多变量Cox比例风险模型分析辅助化疗期间发生血液系统和非血液系统并发症与短期和长期病死率之间的联系。

结果

在738例患者中,73例(9.9% )患者因辅助化疗产生并发症需要急诊住院治疗,血液系统并发症可导致术后90 d病死率升高(HR=5.63,95% CI:1.26~24.81),在肿瘤分期为0~Ⅱ期的腺癌、无论切缘是否有残留的患者中尤为明显,食管腺癌术后5年疾病相关病死率显著升高(HR=3.21,95% CI:1.05~10.33)。在预计预后较差组(肿瘤分期Ⅲ~Ⅳ期)发生非血液系统并发症术后5年病死率较高(HR=2.34,95% CI:1.17~4.89)。其他亚组患者发生血液系统或非血液系统并发症并不影响5年病死率。

结论

食管癌患者接受食管切除术后行辅助化疗,发生相关并发症可能对患者近期及远期病死率产生不利影响。

Objective

Previous researchers have focused upon the influence of postoperative complications on prognosis of esophagectomy, with very little attention paid to the potential negative effects of complications during neoadjuvant therapy. The hypothesis under investigation in this study was that the prognosis after esophageal cancer surgery is negatively influenced by complications causing hospital admission during neoadjuvant therapy.

Methods

Patients receiving neoadjuvant therapy and surgery for esophageal cancer between 2003 and 2011 were identified and followed up until 2017. The association between hematological and non-hematological complications during neoadjuvant therapy and risks of short-term and long-term mortality after surgery were analyzed using a multivariable Cox proportional hazards model, providing hazard ratios (HRs) with 95% confidence intervals (CIs). The HRs were adjusted for appropriate confounding variables.

Results

Among 738 patients, complications during neoadjuvant therapy requiring emergency hospitalization affected 73 (9.9%) patients. Hematological complications were associated with an increased 90-day overall mortality (HR=5.63, 95% CI: 1.26-24.81), especially in patients with stage 0-Ⅱ regardless of whether there were residuals in incisal margins; and the disease-related mortality rate of esophageal adenocarcinoma was significantly increased after 5 years (HR=3.21, 95% CI: 1.05-10.33). In the prognosis group of poor expectances (tumor stage Ⅲ-Ⅳ) with non-hematologic complications, there was a high mortality rate at 5 years after surgery (HR=2.34, 95% CI: 1.17-4.89). Hematological or non-hematologic complications in other subgroups did not affect the 5-year mortality rate.

Conclusions

Adjuvant chemotherapy after esophagectomy for patients with esophageal cancer may cause complications which will adversely affect the short-term and long-term mortality.

表1 患者并发症发生情况[n(%)]
表2 食管癌患者术后辅助化疗发生并发症与病死率的关系[HR(95% CI)]
表3 食管癌患者术后辅助化疗发生血液系统并发症与病死率的关系[HR(95% CI]
表4 食管癌患者术后辅助化疗发生非血液系统并发症与病死率的关系[HR(95% CI]
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