第一临床医学院知识库

目的  食管癌是我国常见的上消化道恶性肿瘤之一。本研究通过回顾性队列研究的方法对III期食管癌患者行不同治疗方案进行生存分析对比，纳入患者接受的治疗方案包括新辅助化疗、术后辅助化疗以及单纯手术治疗。比较三种治疗方案的优劣，为今后该期患者治疗方案的制定提供相关证据支持。

方法  回顾性队列研究：调取就诊于兰州大学第一医院胸外科2010年1月1日至2014年12月31日所有III期食管癌患者作为研究对象。根据采用治疗方案的不同，将纳入患者分为三组，分别是：①新辅助化疗组；②术后辅助化疗组；③单纯手术组。提取纳入患者住院期间的病历及相关资料中基本信息和数据。应用SPSS 24.0软件进行统计学分析，计数资料采取卡方检验，采用Kaplan-Meier法进行生存分析，绘制Kaplan-Meier生存曲线。利用Log-Rank (Mantel-Cox)检验比较三种不同治疗方案的生存收益，并计算各组间风险比（HR）。以P<0.05为差异具有统计学意义。

结果  生存分析结果显示：最终共计纳入患者127例，其中新辅助化疗组患者19例，术后辅助化疗组患者65例，单纯手术组患者43例。新辅助化疗组平均总生存时间28.89（25.09-32.70）个月，术后辅助化疗组平均总生存时间27.97（25.61-30.33）个月，单纯手术组平均总生存时间21.12（17.55-24.68）个月。利用Log-Rank（Mantel-Cox）检验分别两两对比计算卡方值及风险比（HR）：χ2（新辅助化疗组vs.术后辅助化疗组）OS=0.01，P=0.93，P>0.05，两组间总生存期（OS）无统计学差异；HR（新辅助化疗组vs.术后辅助化疗组）OS=1.03（0.52-2.04），新辅助化疗组总生存期略优于术后辅助化疗组，但二者生存差异无统计学意义。χ2（新辅助化疗组vs.单纯手术组）OS=4.02，P=0.04，P<0.05，两组间总生存期（OS）有统计学差异；HR（新辅助化疗组vs.单纯手术组）OS=0.51（0.28-0.94），新辅助化疗组总生存期优于单纯手术组，二者生存差异具有统计学意义。χ2（术后辅助化疗组vs.单纯手术组）OS=8.99，P=0.003，P<0.05，两组间总生存期（OS）有统计学差异；HR（术后辅助化疗组vs.单纯手术组）OS=0.50（0.30-0.83），术后辅助化疗组总生存期优于单纯手术组，二者生存差异具有统计学意义。新辅助化疗组肿瘤无进展生存时间25.95（21.23-30.67）个月，术后辅助化疗组肿瘤无进展生存时间26.07（23.48-28.67）个月，单纯手术组肿瘤无进展生存时间19.58（16.08-23.08）个月。利用Log-Rank（Mantel-Cox）检验分别两两计算卡方值及风险比（HR）：χ2（新辅助化疗组vs.术后辅助化疗组）PFS=0.01，P=0.99，P>0.05，两组间肿瘤无进展生存期（PFS）无统计学差异；HR（新辅助化疗组vs.术后辅助化疗组）PFS=1.00（0.51-1.95），术后辅助化疗组肿瘤无进展生存期略优于新辅助化疗组，但二者生存差异无统计学意义。χ2（新辅助化疗组vs.单纯手术组）PFS=3.92，P=0.04，P<0.05，两组间肿瘤无进展生存期（PFS）有统计学差异；HR（新辅助化疗组vs.单纯手术组）PFS=0.52（0.29-0.94），新辅助化疗组肿瘤无进展生存期优于单纯手术组，二者生存差异具有统计学意义。χ2（术后辅助化疗组vs.单纯手术组）PFS=8.44，P=0.004，P<0.05，两组间肿瘤无进展生存期（PFS）有统计学差异；HR（术后辅助化疗组vs.单纯手术组）PFS=0.52（0.32-0.85），术后辅助化疗组肿瘤无进展生存期优于单纯手术组，二者生存差异具有统计学意义。

结论  回顾性队列研究生存分析显示：新辅助化疗对比术后辅助化疗二者生存差异无统计学意义。新辅助化疗对比单纯手术治疗、术后辅助化疗对比单纯手术治疗生存差异具有统计学意义。对于III期食管癌患者，相较于单纯手术治疗，术前新辅助化疗以及术后辅助化疗生存优势明显，是III期食管癌较为可行的治疗方案。

Objective  Esophageal cancer is one of the common upper gastrointestinal malignancies in our country. In this study, the survival of patients with stage III esophageal cancer underwent neoadjuvant chemotherapy, postoperative chemotherapy and surgery alone were analyzed retrospectively by retrospective cohort study to compare the advantages and disadvantages of the three, and to provide a reference for the research and treatment of esophageal cancer in the future.

Method  Retrospective cohort study: the esophagus cancer patients with stage III that treated in the Department of Thoracic surgery of the First Hospital of Lanzhou University from January 1, 2010 to December 31, 2014 were enrolled. All the included patients were divided into three groups based on the different treatments (Neoadjuvant Chemotherapy, Postoperative Chemotherapy and Surgery alone). We collect the related data of basic information and treatment outcome of these patients. SPSS 24.0 software was used for analysis. Survival analysis was carried out using Kaplan-Meier method, and the survival curve of Kaplan-Meier was drawn. The survival rate was compared by Log-Rank (Mantel-Cox) test. And we calculate the HR value simultaneously.

Results  Survival analysis results shows that 127 patients were divided into Neoadjuvant Chemotherapy group (n=19), Postoperative Chemotherapy group (n=65) and Surgery alone (n=43). In the Neoadjuvant Chemotherapy group, the mean survival time was 28.89 (25.09-32.70) months. In the Postoperative Chemotherapy group, the mean survival time was 27.97 (25.61-30.33) months. And in the Surgery alone group, the mean survival time was 21.12 (17.55-24.68) months. There is significant difference between Neoadjuvant Chemotherapy group vs. Surgery alone group and Postoperative Chemotherapy group vs. Surgery alone group respectively (χ2=4.02, P=0.04, P<0.05 and χ2=8.99, P=0.003, P<0.05). Compared with Surgery alone group, Neoadjuvant Chemotherapy group and Postoperative Chemotherapy group could obviously improve overall survival based on Log-Rank (Mantel-Cox) test. HR=0.51 (0.28-0.94) and 0.50 (0.30-0.83). In addition, in the Neoadjuvant Chemotherapy group, the mean progression free survival was 25.95 (21.23-30.67) months. In the Postoperative Chemotherapy group, the mean progression free survival was 26.07 (23.48-28.67) months. And in the Surgery alone group, the mean progression free survival was 19.58 (16.08-23.08) months. Significant difference between Neoadjuvant Chemotherapy group vs. 
Surgery alone group and Postoperative Chemotherapy group vs. Surgery alone group respectively in progression free survival (χ2=3.92, P=0.04, P<0.05 and χ2=8.44, P=0.004, P<0.05). Compared with Surgery alone group, Neoadjuvant Chemotherapy group and Postoperative Chemotherapy group could improve progression free survival based on Log-Rank (Mantel-Cox) test. HR=0.52 (0.29-0.94) and 0.52 (0.32-0.85).

Conclusion  Survival analysis shows no difference in survival between Neoadjuvant Chemotherapy and Postoperative Chemotherapy. Respectively compared with surgery alone, Neoadjuvant chemotherapy and Postoperative Chemotherapy have obvious statistical difference. For patients with stage III esophageal cancer, Neoadjuvant Chemotherapy and Postoperative Chemotherapy have obvious advantages in survival and are more feasible treatment options for stage III esophageal cancer.