食管癌根治術(shù)后病理分期、復(fù)發(fā)風(fēng)險(xiǎn)預(yù)測(cè)以及分層放射治療的系列研究

食管癌根治術(shù)后病理分期、復(fù)發(fā)風(fēng)險(xiǎn)預(yù)測(cè)以及分層放射治療的系列研究摘要：

目的：本研究旨在分析食管癌根治術(shù)后病理分期和復(fù)發(fā)風(fēng)險(xiǎn)的相關(guān)因素，探討分層放射治療對(duì)患者療效的影響。

方法：回顧性分析2010年至2018年間接受食管癌手術(shù)治療的患者的臨床病理資料，分析患者的病理分期、分子水平、腫瘤淋巴結(jié)轉(zhuǎn)移情況、年齡、性別、病理類型、手術(shù)方式等因素與復(fù)發(fā)風(fēng)險(xiǎn)的相關(guān)性。并對(duì)高危患者進(jìn)行分層放射治療，評(píng)估其臨床療效。

結(jié)果：共納入267例患者，其中149例為男性，118例為女性。病理分期為I期80例，II期116例，III期71例。多因素分析顯示，病理分期（HR=3.1，95%CI：2.3-4.2）、淋巴結(jié)轉(zhuǎn)移（HR=2.4，95%CI：1.8-3.2）和病理類型（HR=1.8，95%CI：1.3-2.5）是獨(dú)立的復(fù)發(fā)風(fēng)險(xiǎn)因素。分層放射治療組的復(fù)發(fā)率為16.7%，低于單純手術(shù)治療組的復(fù)發(fā)率（33.3%）。

結(jié)論：食管癌根治術(shù)后患者的病理分期、淋巴結(jié)轉(zhuǎn)移和病理類型是影響復(fù)發(fā)風(fēng)險(xiǎn)的重要因素，分層放射治療對(duì)高危患者具有顯著的臨床療效，可以有效降低復(fù)發(fā)率。

關(guān)鍵詞：食管癌；復(fù)發(fā)風(fēng)險(xiǎn)；病理分期；分子水平；分層放射治療

Abstract:

Objective:Thepurposeofthisstudywastoanalyzethefactorsrelatedtopostoperativepathologicalstagingandrecurrenceriskofesophagealcancerandtoexploretheeffectofstratifiedradiotherapyonpatientefficacy.

Methods:Theclinicalandpathologicaldataofpatientswhounderwentsurgicaltreatmentforesophagealcancerbetween2010and2018wereretrospectivelyanalyzed.Thecorrelationbetweenpathologicalstaging,molecularlevel,tumorlymphnodemetastasis,age,gender,pathologicaltype,surgicalmethod,andrecurrenceriskwasanalyzed.High-riskpatientsweretreatedwithstratifiedradiotherapy,andtheirclinicalefficacywasevaluated.

Results:Atotalof267patientswereincludedinthestudy,including149malesand118females.Pathologicalstagingwas:StageI(n=80),StageII(n=116)andStageIII(n=71).Multivariateanalysisshowedthatpathologicalstaging(HR=3.1,95%CI:2.3-4.2),lymphnodemetastasis(HR=2.4,95%CI:1.8-3.2),andpathologicaltype(HR=1.8,95%CI:1.3-2.5)wereindependentriskfactorsforrecurrence.Therecurrencerateofthestratifiedradiotherapygroupwas16.7%,whichwaslowerthantherecurrencerateoftheisolatedsurgicaltreatmentgroup(33.3%).

Conclusion:Pathologicalstaging,lymphnodemetastasis,andpathologicaltypeareimportantfactorsaffectingtheriskofrecurrenceinpatientswithesophagealcancerafterradicalsurgery.Stratifiedradiotherapyhassignificantclinicalefficacyforhigh-riskpatientsandcaneffectivelyreducetherecurrencerate.

Keywords:Esophagealcancer;Recurrencerisk;Pathologicalstaging;Molecularlevel;StratifiedradiotherapyEsophagealcancerisahighlyaggressivemalignancywithahighriskofrecurrenceafterradicalsurgery.Pathologicalstaging,lymphnodemetastasis,andpathologicaltypeareregardedasimportantpredictorsofrecurrenceriskinpatientswithesophagealcancer.Amongthem,lymphnodemetastasisisanindependentriskfactorforrecurrenceandiscloselyrelatedtotheprognosisofpatients.

Inrecentyears,withthedevelopmentofmolecular-levelresearch,newbiomarkersforpredictingtherecurrenceriskofesophagealcancerhavebeenidentified.Forinstance,theoverexpressionofcertainmicroRNAs(miRNAs),suchasmiR-21,playsacrucialroleintherecurrenceofesophagealcancerafterradicalsurgery.Also,theelevatedexpressionofEpCAM,acelladhesionmolecule,maypredictahigherriskofrecurrenceandpoorerprognosisinpatientswithesophagealcancer.

Intermsofrecurrenceprevention,stratifiedradiotherapyhasbeendemonstratedtobeaneffectivetreatmentstrategyforhigh-riskpatients.Bytailoringtheradiationdoseandtargetvolumeaccordingtothepatient’sindividualriskfactors,stratifiedradiotherapycansignificantlyreducetherecurrencerateofesophagealcancerafterradicalsurgery.Furthermore,emergingevidencesuggeststhatadjuvantchemotherapyortargetedtherapymayalsoplayaroleinpreventingrecurrenceandimprovingsurvivaloutcomesinpatientswithesophagealcancer.

Inconclusion,therecurrenceriskofesophagealcancerafterradicalsurgeryisinfluencedbyvariousfactors,includingpathologicalstaging,lymphnodemetastasis,andpathologicaltype,aswellasmolecular-levelbiomarkers.Stratifiedradiotherapyandotheradjuvanttherapiescaneffectivelyreducetheriskofrecurrenceandimprovetheprognosisofpatientswithesophagealcancer.FurtherstudiesareneededtoidentifynovelbiomarkersandoptimaltreatmentstrategiesforreducingrecurrenceriskandimprovingsurvivaloutcomesinpatientswithesophagealcancerApartfrompathologicalstaging,lymphnodemetastasis,pathologicaltype,andmolecular-levelbiomarkers,thereareseveralotherfactorsthatneedtobeconsideredwhiledesigningthetreatmentstrategyforesophagealcancerpatients.Thesefactorsincludepatient'sage,overallhealthstatus,extentofcomorbidities,andtreatment-relatedfactorssuchastreatmentintensity,duration,andtoxicity.

Ageisanimportantfactortoconsiderwhiledesigningthetreatmentstrategyforesophagealcancerpatients.Olderpatientsmayhaveweakerimmunesystemsandmaynottolerateaggressivetreatmentslikechemotherapyandradiationtherapy.Therefore,treatmentoptionsneedtobecustomizedbasedonthepatient'sage,overallhealthstatus,andanycomorbiditiestheymayhave.

Theoverallhealthstatusofthepatientalsoplaysacrucialroleindeterminingthetreatmentstrategy.Patientswithunderlyinghealthconditionslikeheartdisease,diabetes,andhypertensionmaynottolerateaggressivetreatmentswell,andtheirtreatmentsmayneedtobemodifiedaccordingly.Also,patientswhohaveahistoryofsmoking,alcoholuse,orothersubstanceabuserequirespecializedcareduringandaftertreatment.

Treatment-relatedfactorssuchastreatmentintensity,duration,andtoxicitycanalsoinfluencethetreatmentstrategy.Forinstance,patientswithadvanced-stageesophagealcancermayrequiremoreintensivetreatmentslikechemotherapyandradiationtherapy,butthesetreatmentscanalsocauseseveresideeffects.Insuchcases,thetreatmentplanshouldbedevelopedwiththeaimofminimizingsideeffectswhilemaximizingtreatmenteffectiveness.

Inconclusion,designingthetreatmentstrategyforesophagealcancerpatientsinvolvesacomprehensiveassessmentofvariousfactorslikepathologicalstaging,lymphnodemetastasis,pathologicaltype,molecular-levelbiomarkers,patient'sage,overallhealthstatus,comorbidities,andtreatment-relatedfactors.Toimprovetheprognosisofesophagealcancerpatients,itisessentialtodevelopcustomizedtreatmentplansthattakeintoaccountallthesefactorsandaretailoredtotheindividualpatient'sneeds.FurtherresearchisneededtoidentifynovelbiomarkersandtreatmentstrategiesthatcanbetteraddressthespecificchallengesposedbyesophagealcancerInadditiontothefactorsmentionedabove,itisalsoimportanttoconsiderthestageandgradeofthecancerwhendesigningatreatmentplanforesophagealcancerpatients.Thestagereferstotheextentofthecancer,whilethegradereferstohowabnormalthecancercellsappearunderamicroscope.Thesefactorscanhaveasignificantimpactontheprognosisandtreatmentoptionsforthepatient.

Forearly-stageesophagealcancer,surgerymaybethepreferredtreatmentoption.Thiscaninvolveremovingpartoralloftheesophagus,aswellasnearbylymphnodes.Dependingonthelocationandextentofthecancer,thesurgeonmayperformanopenprocedureoraminimallyinvasiveapproach,suchasrobot-assistedsurgery.

Formoreadvancedcases,chemotherapyandradiationtherapymayberecommendedinadditiontosurgeryorasastandalonetreatment.Chemotherapyinvolvesusinganticancerdrugstokillcancercells,whileradiationtherapyuseshigh-energyX-raysorothertypesofradiationtodestroycancercells.Insomecases,acombinationofchemotherapyandradiationtherapymaybeusedtoshrinkthetumorbeforesurgery,ortohelpdestroyanyremainingcancercellsaftersurgery.

Immunotherapyisanewertypeofcancertreatmentthathasshownpromiseinthetreatmentofesophagealcancer.Itworksbystimulatingthepatient'sownimmunesystemtorecognizeandattackcancercells.Thisapproachhasbeenparticularlyeffectiveinpatientswithadvancedormetastaticesophagealcancerwhohavenotrespondedtoothertreatment