CAJ | 학술논문

目的回顾性分析食管癌术后残端不典型增生及癌残留患者不同治疗方式的疗效.方法选择胸段食管癌根治术后残端不典型增生及癌残留患者182例,其中采用术后放疗(RT)40例,术后化疗(CT)48例,术后放化疗(RCT) 32例,术后未治疗(NT)62例,比较治疗状况对全组及不同病理分期的疗效差异.Kaplan-Meier法计算局部控制率、总生存率并Logrank检验,Cox回归模型进行多因素分析.结果随访率为93.4％,随访时间满2、3年者分别为88、38例.局部复发率残端不典型增生Ⅰ～Ⅱ级为22％、Ⅲ级加原位癌为35％、浸润癌为36％(x2 =3.49,P=0.175).全组RT,CT,RCT,NT的2、3年局部控制率分别为81％、81％,61％、57％,73％、73％,49％、42％(x2=13.38,P=0.004),残端不典型增生Ⅰ～Ⅱ级的分别为100％、100％,77％、68％,100％、100％,60％、45％(x2=7.09,P=0.069)；全组的总生存率分别为85％、74％,67％、48％,73％、56％,44％、26％(x2=20.24,P=0.000),残端不典型增生Ⅰ～Ⅱ级的分别为100％、100％,79％、54％,33％、33％,75％、34％(x2=9.89,P=0.020),病理分期Ⅰ～Ⅱ期残端阳性的分别为80％、80％,55％、55％,93％、77％,38％、30％(x2=12.34,P =0.006).结论食管癌术后残端不典型增生Ⅰ～Ⅱ级和残端阳性均有较高的局部复发率,残端不典型增生Ⅰ～Ⅱ级及残端阳性Ⅰ～Ⅱ期患者推荐采用术后RT,Ⅲ期患者采用术后RCT可能较为合理.
목적 회고성분석식관암술후잔단불전형증생급암잔류환자불동치료방식적료효.방법 선택흉단식관암근치술후잔단불전형증생급암잔류환자182례,기중채용술후방료(RT)40례,술후화료(CT)48례,술후방화료(RCT) 32례,술후미치료(NT)62례,비교치료상황대전조급불동병리분기적료효차이.Kaplan-Meier법계산국부공제솔、총생존솔병Logrank검험,Cox회귀모형진행다인소분석.결과 수방솔위93.4％,수방시간만2、3년자분별위88、38례.국부복발솔잔단불전형증생Ⅰ～Ⅱ급위22％、Ⅲ급가원위암위35％、침윤암위36％(x2 =3.49,P=0.175).전조RT,CT,RCT,NT적2、3년국부공제솔분별위81％、81％,61％、57％,73％、73％,49％、42％(x2=13.38,P=0.004),잔단불전형증생Ⅰ～Ⅱ급적분별위100％、100％,77％、68％,100％、100％,60％、45％(x2=7.09,P=0.069)；전조적총생존솔분별위85％、74％,67％、48％,73％、56％,44％、26％(x2=20.24,P=0.000),잔단불전형증생Ⅰ～Ⅱ급적분별위100％、100％,79％、54％,33％、33％,75％、34％(x2=9.89,P=0.020),병리분기Ⅰ～Ⅱ기잔단양성적분별위80％、80％,55％、55％,93％、77％,38％、30％(x2=12.34,P =0.006).결론 식관암술후잔단불전형증생Ⅰ～Ⅱ급화잔단양성균유교고적국부복발솔,잔단불전형증생Ⅰ～Ⅱ급급잔단양성Ⅰ～Ⅱ기환자추천채용술후RT,Ⅲ기환자채용술후RCT가능교위합리.
Objective To retrospectively analyze the therapeutic effects of different treatment modalities in thoracic esophageal cancer (EC) patients with atypical hyperplasia in the esophageal stump and esophageal stump cancer after esophagectomy.Methods From August 2006 to December 2010,182thoracic EC patients with atypical hyperplasia in the esophageal stump and esophageal stump cancer after esophagectomy were included in the study.Of the patients,40 received postoperative radiotherapy (RT),48 received postoperative chemotherapy (CT),32 received postoperative radiochemotherapy (RCT),and 62 received no treatment (NT) after operation.The therapeutic effects of different treatment modalities were compared in all patients,in patients with atypical hyperplasia in the esophageal stump after esophagectomy,and in patients with esophageal stump cancer after esophagectomy.The Kaplan-Meier method was used to calculate local control (LC) and overall survival (OS) rates,and the logrank test was used for survival difference analysis.The Cox model was used for multivariate prognostic analysis.Results The follow-up rate was 93.4％ ;88 patients were followed up for at least 2 years,and 38 for at least 3 years.The local recurrence (LR) rates were 22％ in the patients with grade Ⅰ-Ⅱ atypical hyperplasia in the esophageal stump,35％ in the patients with grade Ⅲ atypical hyperplasia in the esophageal stump and carcinoma in situ,and 36％ in the patients with invasive carcinoma (x2 =3.49,P =0.175).For all patients,the 2-and 3-year LC rates were 81％ and 81％ in those receiving RT,61％ and 57％ in those receiving CT,73％ and 73％ in those receiving RCT,and 49％ and 42％ in those receiving NT (x2 =13.38,P =0.004).For the patients with grade Ⅰ-Ⅱ] atypical hyperplasia in the esophageal stump,the 2-and 3-year LC rates were 100％ and 100％ in those receiving RT,77％ and 68％ in those receiving CT,100％ and 100％ in those receiving RCT,and 60％ and 45％ in those receiving NT (x2 =7.09,P =0.069).For all patients,the 2-and 3-year OS rates were 85％ and 74％ in those receiving RT,67％ and 48％ in those receiving CT,73％and 56％ in those receiving RCT,and 44％ and 26％ in those receiving NT (x2 =20.24,P =0.000).For the patients with grade Ⅰ-Ⅱ atypical hyperplasia in the esophageal stump,the 2-and 3-year OS rates were 100％ and 100％ in those receiving RT,79％ and 54％ in those receiving CT,33％ and 33％ in those receiving RCT,and 75％ and 34％ in those receiving NT (x2 =9.89,P =O.020).For the patients with grade Ⅰ-Ⅱ positive esophageal stump,the 2-and 3-year OS rates were 80％ and 80％ in those receiving RT,55％ and 55％ in those receiving CT,93％ and 77％ in those receiving RCT,and 38％ and 30％ in those receiving NT (x2 =12.34,P =0.006).Conclusions The thoracic EC patients with grade Ⅰ-Ⅱatypical hyperplasia in the esophageal stump and positive esophageal stump after esophagectomy have high LR rates.Postoperative RT is recommended for the patients with grade Ⅰ-Ⅱ atypical hyperplasia in the esophageal stump and the patients with grade Ⅰ-Ⅱ positive esophageal stump,while it may be reasonable to recommend postoperative RCT for the patients with grade Ⅲ positive esophageal stump.