CAJ | 학술논문

目的评价局部晚期食管鳞状细胞癌(FSCC)手术后放射治疗和化疗的疗效.方法将1997年1月至2004年6月间入院的158例ESCC(Ⅱ-Ⅲ期)患者随机分为术后放化疗组(78例)和单纯手术组(80例).后经微调和排查,实际术后放化疗组为74例,单纯手术组为77例.对比两组患者的并发症发生率、局部复发率和远处转移率、生存率及无进展生存率.结果患者平均随访45个月,术后放化疗组的并发症发生率与单纯手术组比较,差异无统计学意义(P>0.05).术后放化疗组局部复发和远处转移率低于单纯手术组(P<0.05).术后放化疗组的中位生存时间(53.5个月)与单纯手术组(37个月)比较,差异有统计学意义(P<0.05),两组的1年生存率比较,差异无统计学意义(P>0.05),但3、5和10年生存率比较,术后放化疗组优于单纯手术组(P<0.05).术后放化疗组的中位无进展生存期(46个月)与单纯手术组(34个月)比较,差异有统计学意义(P<0.05),两组1年无进展生存率比较,差异无统计学意义(P>0.05),但3、5和10年无进展生存率比较,术后放化疗组优于单纯手术组(P<0.05).结论术后合理应用放化疗可有效提高局部晚期ESCC患者的无进展生存时间及长期生存率.
목적 평개국부만기식관린상세포암(FSCC)수술후방사치료화화료적료효.방법 장1997년1월지2004년6월간입원적158례ESCC(Ⅱ-Ⅲ기)환자수궤분위술후방화료조(78례)화단순수술조(80례).후경미조화배사,실제술후방화료조위74례,단순수술조위77례.대비량조환자적병발증발생솔、국부복발솔화원처전이솔、생존솔급무진전생존솔.결과 환자평균수방45개월,술후방화료조적병발증발생솔여단순수술조비교,차이무통계학의의(P>0.05).술후방화료조국부복발화원처전이솔저우단순수술조(P<0.05).술후방화료조적중위생존시간(53.5개월)여단순수술조(37개월)비교,차이유통계학의의(P<0.05),량조적1년생존솔비교,차이무통계학의의(P>0.05),단3、5화10년생존솔비교,술후방화료조우우단순수술조(P<0.05).술후방화료조적중위무진전생존기(46개월)여단순수술조(34개월)비교,차이유통계학의의(P<0.05),량조1년무진전생존솔비교,차이무통계학의의(P>0.05),단3、5화10년무진전생존솔비교,술후방화료조우우단순수술조(P<0.05).결론 술후합리응용방화료가유효제고국부만기ESCC환자적무진전생존시간급장기생존솔.
Objective To investigate the role of postoperative chemoradiotherapy ( CRT) as a multimodality treatment option for locally advanced thoracic esophageal squamous cell carcinoma (ESCC) by a prospective comparison between surgery alone and postoperative CRT. Methods Using preoperative computed tomography (CT)-based staging criteria, 158 patients with ESCC (stage Ⅱ-Ⅲ) were enrolled in this prospective study. With informed consent, the patients were randomized into two groups: postoperative CRT (78 cases ) and surgery alone (S, 80 cases). After a few minor adjustments to the enrolled patients, the actual patients of postoperative CRT group and S group were 74 cases and 77 cases, respectively. Comparison of the complications, local recurrence rate, distant metastasis rate, survival rate and progression-free survival in the two groups was carried out. Results With a median follow-up of 37.5 months, the 1-,3-,5-, 10-year overall survival (OS) rates were 91.0% , 62.8%,42.3%,24.4% and 87.5% , 51.3% , 33.8% , 12. 5% for the postoperative CRT and S arm, respectively. A significant difference in OS was detected between the two arms (P =0.0276). There was a significant difference of progression-free survival (PFS) between the two arms (P=0.0136). The local recurrence rates in the postoperative CRT group and S group were 14.9% and 36.4% , respectively (P<0.05). No significant difference was detected between the complications of the two groups ( P > 0. 05). Toxicities of chemoradiotherapy in the postoperative CRT arm were moderate, which can be relieved rapidly by adequate therapy. Conclusion Rational application of postoperative chemoradiotherapy can provide a benefit in progression-free survival and overall survival in patients with locally advanced esophageal squamous cell carcinoma.