CAJ | 학술논문

目的探讨胸段食管癌术后复发、转移的临床特征，了解术后放疗的靶区。方法回顾性分析144例食管癌术后复发转移部位，应用最优尺度分析描述其分布与原发肿瘤部位关系。结果144例术后复发转移病例肿瘤中位进展时间18.43个月（15.68~21.18个月）。共发生复发转移362个部位，其中吻合口复发、远处转移、颈部/锁骨上淋巴结、Ⅰ~Ⅱ区、Ⅲ区、Ⅳ区、Ⅴ区、Ⅵ区、Ⅶ区、Ⅷ区、Ⅹ~Ⅺ区、腹部淋巴结转移分别是19例（13.2%）、48例（33.3%）、52例（36.1%）、40例（27.8%）、34例（23.6%）、45例（31.3%）、35例（24.3%）、2例（1.4%）、45例（31.3%）、13例（9.0%）、1例（0.7%）、28例（19.4%）。原发灶在胸上段的与颈部/锁骨上转移，吻合口无复发有联系；原发灶在胸中段的与无远处转移、腹部淋巴结无转移、Ⅲ区、Ⅶ区转移有联系；原发灶在胸下段的与远处转移、腹部淋巴结转移，颈部/锁骨上淋巴结、Ⅰ~Ⅱ区、Ⅲ区、Ⅳ区、Ⅴ区、Ⅶ区无转移有联系。其他淋巴结区情况尚无法明确。结论不支持胸段食管癌术后包括颈部/锁骨上、纵隔及腹部淋巴结等部位的大野照射；不同原发灶部位建议区别对待，胸上段食管癌颈部/锁骨上区为必需照射靶区，吻合口可不作为靶区；胸中段食管癌3区、7区为必需照射靶区，腹部淋巴结可不作为靶区，可不加用化疗。胸下段食管癌颈部/锁骨上、Ⅰ~Ⅱ区、Ⅲ区、Ⅳ区、Ⅴ区、Ⅶ区可不作为靶区，腹部淋巴结必需作为靶区，因胸下段食管癌因与远处转移有联系，建议加用化疗。胸上段食管癌病例数较少，结果不一定可信。
목적탐토흉단식관암술후복발、전이적림상특정，료해술후방료적파구。방법회고성분석144례식관암술후복발전이부위，응용최우척도분석묘술기분포여원발종류부위관계。결과144례술후복발전이병례종류중위진전시간18.43개월（15.68~21.18개월）。공발생복발전이362개부위，기중문합구복발、원처전이、경부/쇄골상림파결、Ⅰ~Ⅱ구、Ⅲ구、Ⅳ구、Ⅴ구、Ⅵ구、Ⅶ구、Ⅷ구、Ⅹ~Ⅺ구、복부림파결전이분별시19례（13.2%）、48례（33.3%）、52례（36.1%）、40례（27.8%）、34례（23.6%）、45례（31.3%）、35례（24.3%）、2례（1.4%）、45례（31.3%）、13례（9.0%）、1례（0.7%）、28례（19.4%）。원발조재흉상단적여경부/쇄골상전이，문합구무복발유련계；원발조재흉중단적여무원처전이、복부림파결무전이、Ⅲ구、Ⅶ구전이유련계；원발조재흉하단적여원처전이、복부림파결전이，경부/쇄골상림파결、Ⅰ~Ⅱ구、Ⅲ구、Ⅳ구、Ⅴ구、Ⅶ구무전이유련계。기타림파결구정황상무법명학。결론불지지흉단식관암술후포괄경부/쇄골상、종격급복부림파결등부위적대야조사；불동원발조부위건의구별대대，흉상단식관암경부/쇄골상구위필수조사파구，문합구가불작위파구；흉중단식관암3구、7구위필수조사파구，복부림파결가불작위파구，가불가용화료。흉하단식관암경부/쇄골상、Ⅰ~Ⅱ구、Ⅲ구、Ⅳ구、Ⅴ구、Ⅶ구가불작위파구，복부림파결필수작위파구，인흉하단식관암인여원처전이유련계，건의가용화료。흉상단식관암병례수교소，결과불일정가신。
Objective To analyze clinical characteristics of recurrence and metastasis in postoperative thoracic esophageal carcinoma,study the target of prophylactic radiotherapy.Methods retrospective analysis of recurrence and metastasis in 144 patients were done using optimal scaling.Results The median time to progress was18.43 months (15.68-21.18 months) .144 patients had 362 recurrences and metastases.anastomotic stoma recurrences,hematogenous metastases,cervical lymph node,regionⅠ-Ⅱ,regionⅢ,regionⅣ,regionⅤ,regionⅥ,regionⅦ,regionⅧ,regionⅩ-Ⅺ,abdominal lymph node metastases were observed in 19(13.2%),48(33.3%),52(36.1%),40(27.8%),34(23.6%),45(31.3%),35(24.3%),2(1.4%),45(31.3%),13(9.0%),1(0.7%),28 patients (19.4%),respectively.The upper esophagus have relationship with metastases of cervical nodes,non-recurrences of anastomotic stoma;The middle esophagus have relationship with hematogenous non-metastases,non-metastases of abdominal lymph node,metastases of region Ⅲ,regionⅦ;The lower esophagus have relationship with hematogenous metastases,metastases of abdominal lymph node,and non-metastases of cervical lymph node,regionⅠ-Ⅱ,regionⅢ,regionⅣ,regionⅤ,regionⅦ.Conclusion The result did not support that the irradiation field in postoperative thoracic esophageal carcinoma have to include cervia,mediastinum and abdominal lymph node.The irradiation ifeld of different region must be discriminated.In the upper thoracic esophageal carcinoma,cervical lymph node need to be included in the irradiation field,anastomotic stoma was not required as the targets; In the middle thoracic esophageal carcinoma,the regionⅢandⅦneed to be included in the irradiation ifeld ,abdominal lymph node was not required as the targets.chemotherapy is not applied sufifciently.In the lower thoracic esophageal carcinoma,abdominal lymph node need to be included in the irradiation ifeld ,regionⅠ-Ⅱ,Ⅲ,Ⅳ,Ⅴ,Ⅶare not required as the targets.The lower-thoracic carcinoma correlates with hematogenous metastase,so it is suggested that they are applicated chemotherapy.The cases of upper-thoracic esophagus are few,and the results are not entirely credible.