摘要
目的分析胸段食管癌淋巴结转移规律、失败部位，为术后放疗范围提供依据。方法549例食管癌根治术后患者随机进入单纯手术组（275例）和术后放疗组（274例）。术后放疗组术后3～4周开始双锁骨上淋巴引流区和全纵隔放疗50～60Gy分25～30次5～6周完成。结果全组1、2个解剖区域淋巴结转移者5年生存率分别为31．5％、13．9％（P=0．013），单纯手术组淋巴结转移个数≥2个（82例）的分别为24．8％、4．9％（P=0．046）。上、中、下段食管癌淋巴结切除均数分别为13、17、20个，上、中、下段食管癌淋巴结转移率分别为26．1％、49．6％、64．9％（X^2=15.51，P〈0．01）。胸段食管癌食管旁、纵隔、胃周围（贲门左、贲门右、胃小弯）淋巴结转移率分别为33．2％、12．4％、30．4％（X^2=79．93，P〈0．01），在上、中、下段食管癌中食管旁淋巴结阳性率相似（61．5％、65．6％、64．9％，X^2=0．16，P〉0．05）。在单纯手术组，纵隔淋巴结转移和锁骨上淋巴结转移失败率上、中段分别为26．7％、29．8％和16．7％、14．3％。上二段食管癌吻合口的复发率16．7％明显的高于中、下段（3．1％、7．7％，X^2=9．02，P=0．011）。结论食管癌术后生存率受淋巴结转移区域多少的影响。上段食管癌淋巴结转移率低町能与淋巴结清扫个数少有关，发生在食管旁淋巴结转移率最高，且不受病变部位的影响。上、中段食管癌除纵隔、锁骨上区域的复发率高外，上段食管癌的吻合口也很高，这些部位应是术后放疗的重点。
Objective To analyze the rule of lymph node metastasis in thoracic esophageal carcinoma,and to study the proper radiation target. Methods From September 1986 to December 1997,549 patients with esophageal carcinoma who had undergone radical resection were divided into surgery alone group （S,275 patients） or surgery plus radiotherapy group（ S ＋ R,274 patients）. Radiotherapy was begun 3 to 4 weeks after operation. The radiation target included both supra-clavicular areas and the entire mediastinum. The total dose was 50 Gy in 25 fractions over 5 weeks for the supra-clavicular areas and 60 Gy in 30 fractions over 6 weeks for the entire mediastinum. Results The 5-year overall survival of patients with lymph node metastasis in one anatomic site and two anatomic sites was 31.5% and 13.9% （P = 0. 013 ） ,respectively. For patients with 〉 2 positive nodes metastasis receiving surgery alone, the corresponding 5-year survival was 24.8% and 4.9% （P =0. 046）,respectively. The median number of dissected lymph nodes of the upper-, middle-and lower-segment esophageal carcinoma was 13,17 and 20, respectively. The rate of metastatic lymph node in the para-esophagus region was the highest （61.5% -64.9% ） ,which was not different among the different primary sites （P = 0.922）. The anastomotic stoma recurrence rate of the upper-segment esopha- geal carcinoma was higher than that of the middle- or lower-segment carcinomas （ 16.7 %, 3.1% , and 7.7 % , X^2 = 9.02, P 〈 0.05）. Conclusions For the thoracic esophageal carcinoma, the number of anatomic sites of lymph node metastasis is an important factor affecting the survival. The lower rate of lymph node metasta- sis of the upper segment esophageal carcinoma may be corrected with the less lymph node dissected. The rate of lymph node metastasis in para-esophageal region is not related with the lesion segment. The anastomotic stoma is an important radiotherapy target for upper segment esophageal carcinoma.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2008年第6期427-431,共5页
Chinese Journal of Radiation Oncology
基金
首都医学发展科研基金（2007-2022）
关键词
食管肿瘤/放射疗法
淋巴结转移规律
术后放疗范围
Esophageal neoplasms/radiotherapy
Rule of the lymph node metastasis
Field ofpostoperative radiotherapy
