背景:替加氟-尿嘧啶辅助治疗可以延长非小细胞肺癌患者的术后生存期。一些患者由于厌食症等胃肠道疾病而停止治疗,相关因素和肺叶切除术的影响尚不清楚。本研究旨在评估肺叶切除术后食管移位,并阐明其对替加氟尿嘧啶治疗连续性的影响。
方法:对2009年4月至2019年3月肺叶切除术后接受替加氟-尿嘧啶辅助治疗的患者进行回顾性分析。患者背景,围手术期特点,治疗结果,并比较治疗完成组和停药组的计算机断层扫描测量的食管位移程度。在根据食管移位程度划分的组中进一步进行亚组比较分析。
结果:共对68例患者进行了回顾,包括41名男性和27名女性,平均年龄为66.2岁。共有41名患者完成了2年的辅助治疗,27名患者停止了辅助治疗。两组间的总生存率和无复发生存率有统计学意义(p=0.027,p=0.010)。Th7水平的食管移位程度是治疗停止的重要预测因素(p=0.046,比值比[OR]:1.138,95%置信区间[CI]:1.002-1.291)。在根据受试者工作特征曲线确定的食管高度移位高于基线的患者中,停药的原因是厌食症,在多变量分析中具有显著意义(p=0.013,OR:14.72,95%CI:1.745-124.2)。
结论:我们的研究表明,肺叶切除术后食管的解剖移位可能会影响肺癌患者停止口服辅助化疗。
BACKGROUND: Adjuvant tegafur-uracil therapy has prolonged postoperative survival in patients with non-small cell lung cancer. Some patients experience treatment discontinuation due to gastrointestinal disorders such as anorexia, and the associated factors and the impact of lobectomy remain unclear. This study aimed to assess the postoperative esophageal displacement after lobectomy and to clarify its impact on the continuity of tegafur-uracil treatment.
METHODS: Patients who received adjuvant tegafur-uracil therapy after lobectomy between April 2009 and March 2019 were retrospectively analyzed. Patient background, perioperative characteristics, treatment findings, and the degree of esophageal displacement measured by computed tomography were compared between the treatment completion group and the discontinuation group. A subgroup comparative analysis was further performed in the groups divided according to the degree of esophageal displacement.
RESULTS: A total of 68 patients were reviewed, including 41 males and 27 females with a mean age of 66.2 years old. A total of 41 patients completed the 2-year adjuvant treatment and 27 patients discontinued it. The overall survival and relapse-free survival between the two groups were statistically significant (p = 0.027, p = 0.010). The degree of esophageal displacement at the Th7 level was a significant predictor of treatment discontinuation (p = 0.046, odds ratio [OR]: 1.138, 95% confidence interval [CI]: 1.002-1.291). Among the patients with a high degree of esophageal displacement above the baseline determined from the receiver operating characteristic curve, the cause of discontinuation was anorexia, which was significant in multivariate analysis (p = 0.013, OR: 14.72, 95% CI: 1.745-124.2).
CONCLUSIONS: Our study suggested that anatomical displacement of the esophagus after lobectomy may affect the discontinuation of oral adjuvant chemotherapy in patients with lung cancer.