摘要
目的 探讨淋巴结阳性胸段食管鳞癌术后放化疗的价值.方法 对首程治疗行胸段食管鳞癌三野淋巴结清扫根治术、术后病理证实有淋巴结转移、无远处血行转移的304例胸段食管鳞癌患者进行回顾性分析,其中术后放疗组140例,术后放化疗组164例.术后放疗剂量50 Gy；化疗方案为顺铂加紫杉醇,21 d为1个周期.结果 全组患者1、3和5年生存率分别为90.1％、56.6％和43.3％,中位生存时间为49.7个月.其中术后放化疗组和术后放疗组患者的5年生存率分别为47.4％和38.6％,中位生存时间分别为53.5个月和41.7个月（P=0.030）.化疗1、2、3和4个周期的患者5年生存率分别为24.4％、53.0％、58.1％和43.3％ （P =0.007）.其中化疗1个周期与化疗2～4个周期的患者5年生存率比较,差异有统计学意义（P=0.001）.单因素分析显示,淋巴结转移数目、pT分期、治疗方法和化疗周期数与淋巴结阳性胸段食管鳞癌患者预后有关（均P＜0.05）.多因素分析显示,淋巴结转移数目、pT分期和化疗周期数是影响淋巴结阳性胸段食管鳞癌患者预后的独立因素（均P＜0.05）.术后放化疗组患者的Ⅰ～Ⅱ级中性粒细胞减少、Ⅰ～Ⅱ级放射性食管炎和Ⅰ～Ⅱ级胃肠道反应的发生率明显高于术后放疗组（均P＜0.05）,而晚期并发症的发生率差异无统计学意义（P＞0.05）.结论 术后放化疗能够提高淋巴结阳性胸段食管鳞癌患者的生存率,毒副反应可耐受.
Objective To retrospectively compare the efficacy of postoperative radiotherapy （RT） alone with that of postoperative radiotherapy with concurrent chemotherapy （CRT） for thoracic esophageal squamous cell carcinoma （EPC） with positive lymph nodes,and to evaluate the clinical value of RT ＋ CRT.Methods 304 EPC patients underwent esophagectomy with three-field lymph node dissection had pathological lymph node metastases,but no hematogenous distant metastasis.Among them,140 cases underwent postoperative RT alone,and 164 cases underwent postoperative CRT.The dose of irradiation was 50 Gy,and the chemotherapy regimen was taxol and cis-platinum,and a cycle was 21 days.Results The 1-,3-and 5-year total survival rates of the whole group were 90.1%,56.6% and 43.3%,respectively,with a median survival time of 49.7 months.The 5-year overall survival rates of the CRT and RT groups were 47.4% and 38.6%,respectively （P =0.030）,with a median survival time of 53.5 and 41.7 months,respectively （P =0.030）.The overall survival rates of the patients who underwent 1,2,3,4 cycles of chemotherapy were 24.4%,53.0%,58.1% and 43.3%,respectively （P =0.007）.Among them,the 5-year total survival rate of patients with 2-4 cycles of chemotherapy was significantly better than that of patients who underwent one cycle of chemotherapy （P =0.001）.Univariate analysis showed that number of metastatic lymph nodes,pT stage,therapeutic regimen and number of chemotherapy cycles were significantly correlated with the prognosis of the patients （P 〈 0.05 for all）.Multivariate analysis showed that number of metastatic lymph nodes,pT stage,and number of chemotherapy cycles were independent prognostic factors of the patients （P 〈 0.05 for all）.Early toxic effects including neutropenia,radiation esophagitis,and gastrointestinal effects were significantly more severe in the CRT group than that in the RT group （P 〈0.05）,however,there were no significant differences of late toxic effects between the two groups （P 〉0.05）.Conclusion Postoperative CRT for thoracic EPC with positive lymph nodes can improve the survival rate,with tolerable adverse effects.
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2014年第2期151-154,共4页
Chinese Journal of Oncology
关键词
食管肿瘤
外科手术
放射疗法
药物疗法
预后
Esophageal neoplasms
Surgical procedures, operative
Radiotherapy
Drug therapy
Prognosis
