CAJ | 학술논문

目的分析可手术切除食管鳞癌患者单纯三维适形放疗(3DCRT)结果,为准确判断预后和取得更好疗效提供参考.方法回顾分析本院2002-2007年间92例根治性3DCRT食管癌患者治疗失败原因,Kaplan-Meier法计算复发、转移、局部控制、生存等,Cox法分析影响复发、转移的因素.结果总失败率为51％ (47/92),失败原因中单纯区域性复发29例、单纯远处转移12例、远处转移伴区域性复发6例.区域性复发中胸中段食管癌高于胸上、下段食管癌(23、8、4例,x2=39.36,P =0.000),部分缓解者高于完全缓解者(18、7例,x2=23.44,P=0.000)；远处转移中胸下段食管癌高于胸上中段食管癌(7、6、5例,x2=14.42,P=0.001).多因素分析结果显示N分期、临床分期和近期疗效为影响区域性复发因素；N分期、临床分期、病变X线长度和近期疗效为影响远处转移因素.结论单纯3DCRT后胸上段食管癌患者区域性复发率和远处转移率低于胸中下段食管癌患者,疗后达完全缓解者区域性复发率和远处转移率较低,临床分期仍是影响区域性复发和远处转移的重要因素.
목적 분석가수술절제식관린암환자단순삼유괄형방료(3DCRT)결과,위준학판단예후화취득경호료효제공삼고.방법 회고분석본원2002-2007년간92례근치성3DCRT식관암환자치료실패원인,Kaplan-Meier법계산복발、전이、국부공제、생존등,Cox법분석영향복발、전이적인소.결과 총실패솔위51％ (47/92),실패원인중단순구역성복발29례、단순원처전이12례、원처전이반구역성복발6례.구역성복발중흉중단식관암고우흉상、하단식관암(23、8、4례,x2=39.36,P =0.000),부분완해자고우완전완해자(18、7례,x2=23.44,P=0.000)；원처전이중흉하단식관암고우흉상중단식관암(7、6、5례,x2=14.42,P=0.001).다인소분석결과현시N분기、림상분기화근기료효위영향구역성복발인소；N분기、림상분기、병변X선장도화근기료효위영향원처전이인소.결론 단순3DCRT후흉상단식관암환자구역성복발솔화원처전이솔저우흉중하단식관암환자,료후체완전완해자구역성복발솔화원처전이솔교저,림상분기잉시영향구역성복발화원처전이적중요인소.
Objective To analyse the outcome of patients with resectable esophageal squamous cell carcinoma after receiving three-dimensional conformal radiotherapy (3DCRT) alone,and to provide a reference for accurate prognosis prediction and better therapeutic effect.Methods A retrospective analysis was performed in 92 patients with esophageal cancer,who received radical 3DCRT in our hospital from February 2002 to July 2007,to determine the reasons for treatment failure.The recurrence,metastasis,local control,and survival were calculated by the Kaplan-Meier method ;the influential factors for recurrence and metastasis were analyzed using the Cox model.Results The overall failure rate was 51％ (47/92) ;of the 47 patients,29 had regional recurrence,12 had distant metastasis,and 6 had both distant metastasis and regional recurrence.In the patients with regional recurrence,there were more individuals with middle thoracic esophageal cancer than individuals with upper and lower thoracic esophageal cancers (23 vs 8 and 4,x2 =39.36,P =0.000),and there were more individuals with a partial remission than individuals with a complete remission (18 vs 7,x2 =23.44,P =0.000).In the patients with distant metastasis,there were more individuals with lower thoracic esophageal cancer than individuals with upper and middle thoracic esophageal cancers (7 vs 6 and 5,x2 =14.42,P =0.001).The multivariate analysis showed that N stage,clinical stage,and short-term efficacy were the influential factors for regional recurrence and that N stage,clinical stage,length of tumor on X-ray film,and short-term efficacy were the influential factors for distant metastasis.Conclusions After receiving 3DCRT alone,the patients with upper thoracic esophageal cancer have lower regional recurrence and distant metastasis rates than those with middle and lower thoracic esophageal cancers,and the patients with a complete remission have lower regional recurrence and distant metastasis rates than those with a partial remission.Clinical stage is still an important influential factor for regional recurrence and distant metastasis.