摘要
目的 分析淋巴结转移个数对生存率的影响及放射治疗的意义。方法 4 95例食管癌根治性手术切除患者 ,随机分为单一手术组 (2 75例 )和术后放疗组 (2 2 0例 ) ,根据淋巴结转移的个数分为 3组 :A组无淋巴结转移 ,占 4 7.2 % ;B组淋巴结转移个数 1～ 2枚 ,占 2 9.5 % ;C组淋巴结转移个数≥ 3枚 ,占 2 3.2 %。结果 (1)相同T分期 (T3)时 ,A、B、C三组的 5年生存率分别为 5 2 .6 %、2 8.8%和 10 .9(P =0 .0 0 0 0 ) ;在C组 ,单一手术和术后放疗者的 5年生存率分别为 0和 19.3% (P =0 .0 336 )。 (2 )在淋巴结阳性组 (B +C组 ) ,单一手术和术后放疗者的胸内淋巴结转移率分别为 35 .9%和 2 1.2 % (P =0 .0 14 ) ,锁骨上淋巴结转移率分别为 19.7%和 4 .4 % (P =0 .0 0 0 ) ;在淋巴结阴性组 (A组 ) ,单一手术和术后放疗的胸内淋巴结转移率分别为 2 7.8%和 10 .3% (P =0 .0 0 3) ;A、B、C三组的腹腔淋巴结转移率分别为 3.9%、9.4 %和 17.5 % (P =0 .0 0 0 )。血行转移率以C组最高 ,为 2 7.8%。结论 淋巴结转移个数是影响食管癌生存率的因素之一。淋巴结转移个数≥ 3枚时 ,血行转移率高 ,是全身化疗的指征。术后放疗降低了放疗部位淋巴结转移率 ,明显提高了C组生存率。
Objective To analyze the influence of the number of lymph node metastasis on survival and prophylactic postoperative radiotherapy after radical resection of thoracic esophageal carcinoma. Methods Four hundred and ninety-five patients with thoracic esophageal squamous cell cancer who had undergone radical resection were randomly divided into surgery group alone (S, 275) and surgery plus radiotherapy group (S+R, 220). The patients were classified into three groups: Group A: 234 patients (47.2%) without lymph node involvement; Group B: 146 patients (29.5%) with 1 to 2 involved lymph nodes and Group C: 115 patients (23.2%) with ≥3 involved lymph nodes. Results 1. The 5-year survival rate in Groups A、B and C for the same T stage (T3) was 52.6%, 28.8% and 10.9%, respectively (P=0.0000); the 5-year survival rate in group C was 0% in S group and 19.3% in S+R group (P=0.0336); 2. In the positive lymph node group, the metastatic rate of intra-thoracic and supraclavicular lymph node was 35.9% and 21.2% in S group and 19.7% and 4.4% in S+R group (P=0.014 and P=0.000). In the negative lymph node group, the metastatic rates of intra-thoracic lymph node was 27.8% in S group and 10.3% in S+R group (P=0.003). The metastatic rate of intra-abdominal lymph node in Groups A, B and C was 3.9%, 9.4% and 17.5%, respectively (P= 0.0000). The occurrence of hematogenous metastasis was most frequent in group C(27.8%) with≥3 positive lymph nodes. Conclusion 1. The number of metastatic lymph node is one of the important factors which affects the survival of thoracic esophageal carcinoma. 2. Chemotherapy might be given to the patients with three or more lymph nodes involved who have the possibility of developing hematogenous metastasis. Postoperative radiotherapy can reduce the occurrence of intra-thoracic and supraclavicular lymph node metastasis and improve the survival of patients with three or more lymph nodes involvement.
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2004年第2期112-115,共4页
Chinese Journal of Oncology
关键词
食管癌术
淋巴结转移
生存率
放射治疗
手术
Esophageal neoplasms/surgery
Esophageal neoplasms/radiotherapy
Lymphatic metastasis
