CAJ | 학술논문

目的回顾性分析淋巴结阳性的食管癌患者术后放射治疗的意义.方法自1999年9月至2005年10月,选择260例代表不同淋巴结转移状态的食管癌根治性手术切除患者进行研究.其中,单纯手术组(A组)130例,术后放疗组(B组)130例.根据淋巴结转移的个数分为3个亚组,A1组(无淋巴结转移)42例,A2组(淋巴结转移个数1～3枚)43例,A3组(淋巴结转移个数≥4枚)45例；B1组(无淋巴结转移)43例,B2组(淋巴结转移个数1～3枚)44例,B3组(淋巴结转移个数≥4枚)43例.结果 (1)A和B组的1、3、5年总生存率分别为71.5％、35.4％、20.0％和76.2％、48.5％、36.2％(x2 =7.822,P＜0.05).A1和B1组、A2和B2组及A3和B3组的1、3、5年生存率分别为83.3％、52.3％、38.1％和81.3％、58.1％、46.5％ (x2 =0.283,P＞0.05),69.8％、34.9％、18.6％和77.3％、47.7％、40.9％ (x2 =4.188,P＜0.05)及62.2％、20.0％、4.4％和69.8％、39.5％、20.9％(x2 =6.168,P＜0.05)；B2和B3组生存率分别为40.9％与20.9％ (x2 =4.213,P＜0.05).(2)A1和B1组、A2和B2组及A3和B3组的5年累计淋巴结转移率分别为30.9％和11.6％(x2=4.753,P＜0.05),53.4％和22.7％ (x2 =8.741,P ＜0.05)及66.7％和30.2％(x2=11.682,P＜0.05).(3)A1和B1组、A2和B2组及A3和B3组的5年血行转移率分别为11.9％和13.9％(x2=0.079,P＞0.05),20.9％和20.4％ (x2 =0.003,P ＞0.05)及31.1％和25.6％(x2 =0.203,P＞0.05).结论术后放疗可以提高淋巴结阳性患者的生存率,降低放疗部位的淋巴结转移率,血行转移随淋巴结转移数的增加而增加.
목적 회고성분석림파결양성적식관암환자술후방사치료적의의.방법 자1999년9월지2005년10월,선택260례대표불동림파결전이상태적식관암근치성수술절제환자진행연구.기중,단순수술조(A조)130례,술후방료조(B조)130례.근거림파결전이적개수분위3개아조,A1조(무림파결전이)42례,A2조(림파결전이개수1～3매)43례,A3조(림파결전이개수≥4매)45례；B1조(무림파결전이)43례,B2조(림파결전이개수1～3매)44례,B3조(림파결전이개수≥4매)43례.결과 (1)A화B조적1、3、5년총생존솔분별위71.5％、35.4％、20.0％화76.2％、48.5％、36.2％(x2 =7.822,P＜0.05).A1화B1조、A2화B2조급A3화B3조적1、3、5년생존솔분별위83.3％、52.3％、38.1％화81.3％、58.1％、46.5％ (x2 =0.283,P＞0.05),69.8％、34.9％、18.6％화77.3％、47.7％、40.9％ (x2 =4.188,P＜0.05)급62.2％、20.0％、4.4％화69.8％、39.5％、20.9％(x2 =6.168,P＜0.05)；B2화B3조생존솔분별위40.9％여20.9％ (x2 =4.213,P＜0.05).(2)A1화B1조、A2화B2조급A3화B3조적5년루계림파결전이솔분별위30.9％화11.6％(x2=4.753,P＜0.05),53.4％화22.7％ (x2 =8.741,P ＜0.05)급66.7％화30.2％(x2=11.682,P＜0.05).(3)A1화B1조、A2화B2조급A3화B3조적5년혈행전이솔분별위11.9％화13.9％(x2=0.079,P＞0.05),20.9％화20.4％ (x2 =0.003,P ＞0.05)급31.1％화25.6％(x2 =0.203,P＞0.05).결론 술후방료가이제고림파결양성환자적생존솔,강저방료부위적림파결전이솔,혈행전이수림파결전이수적증가이증가.
Objective To analyze the significance of postoperative radiotherapy for lymph node positive patients after radical resection of esophageal carcinoma.Methods Two hundred and sixty patients with esophageal squamous cell cancer,aged ≤70,with the performance status score of0 -1,who had undergone radical resection were divided into 2 equal groups:surgery alone group (Group A ) and surgery plus radiotherapy group (Group B).Group A was classified into 3 sub-groups:Group A1 (n =42)without lymph node involvement,Group A2 (n =43 ) with 1 to 3 involved lymph nodes,and Group A3(n =45) with ≥4 involved lymph nodes.Group B was classified into 3 sub-groups:Group B1 (n =43 )without lymph node involvement,Group B2 (n =44) with 1 to 3 involved lymph nodes,and Group B3(n =43 ) with ≥4 involved lymph nodes.The patients were followed up till death.Results The 1-,3-,and 5-year overall survival rates of Group A were 71.5％,35.4％ and 20％,respectively,all significantly lower than those in Group B (76.2％,48.5％ and 36.2％,respectively,x2 =7.822,P ＜0.05).The 1-,3-,and 5-year survival rates of Groups A1 were 83.3％,52.3％,and 38.1％,respectively,all not significantly different from those of Group B1 (81.3％,58.1％,and 46.5％,respectively,x2 =0.283,P ＞ 0.05 ).The 1-,3-,and 5-year survival rates of Groups A2 were 69.8％,34.9％,and 18.6％,respectively,all significantly lower than those of Group B2 (77.3％,47.7％,and 40.9％,respectively,x2 =4.188,P ＜ 0.05).The 1-,3-,and 5-year survival rates of Groups A3 were 62.2％,20％,and 4.4％,respectively,all significantly lower than those of Group B3 ( 69.8％,39.5％,and 20.9％,respectively,x2 =6.168,P ＜ 0.05).The 5-year metastatic lymph node rates of Groups A1 to A3 were 30.9％,53.4％,and 66.7％,respectively,all significantly higher than those of Groups B1 to B3 ( 11.6％,22.7％,and 30.2％,respectively,x2 =4.753,8.741,and 11.682,respectively,all P ＜0.05).The 5-year distant metastasis rates of Groups A1 to A3 were 11.9％,20.9％,and 31.1％,respectively,all not significantly different from those of Groups B1 to B3 (13.9％,20.4％,and 25.6％,respectively,x2 =0.079,0.003,and 0.203,respectively,all P ＞ 0.05 ).Conclusions Postoperative radiotherapy increases the survival rate of lymph node positive patients,but shows little efficacy on the lymph node negative patients.It reduces the occurrence of lymph node metastasis,even in the lymph node negative patients,and does not increase the morbidity of complications,especially that of anastomotic stenosis.The number of metastatic lymph node is one of the important factors affecting the survival of esophageal carcinoma.Distant metastasis increases along with the number of metastatic lymph nodes.