High risk factors of hematogenous metastasis in non-surgical thoracic esophageal squamous cell carcinoma after chemoradiotherapy and its influence on survival and prognosis / 中国综合临床

ABSTRACT

Objective: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.