CAJ | 학술논문

目的探讨淋巴结阳性胸段食管鳞癌术后放化疗的价值.方法对首程治疗行胸段食管鳞癌三野淋巴结清扫根治术、术后病理证实有淋巴结转移、无远处血行转移的304例胸段食管鳞癌患者进行回顾性分析,其中术后放疗组140例,术后放化疗组164例.术后放疗剂量50 Gy；化疗方案为顺铂加紫杉醇,21 d为1个周期.结果全组患者1、3和5年生存率分别为90.1％、56.6％和43.3％,中位生存时间为49.7个月.其中术后放化疗组和术后放疗组患者的5年生存率分别为47.4％和38.6％,中位生存时间分别为53.5个月和41.7个月(P=0.030).化疗1、2、3和4个周期的患者5年生存率分别为24.4％、53.0％、58.1％和43.3％ (P =0.007).其中化疗1个周期与化疗2～4个周期的患者5年生存率比较,差异有统计学意义(P=0.001).单因素分析显示,淋巴结转移数目、pT分期、治疗方法和化疗周期数与淋巴结阳性胸段食管鳞癌患者预后有关(均P＜0.05).多因素分析显示,淋巴结转移数目、pT分期和化疗周期数是影响淋巴结阳性胸段食管鳞癌患者预后的独立因素(均P＜0.05).术后放化疗组患者的Ⅰ～Ⅱ级中性粒细胞减少、Ⅰ～Ⅱ级放射性食管炎和Ⅰ～Ⅱ级胃肠道反应的发生率明显高于术后放疗组(均P＜0.05),而晚期并发症的发生率差异无统计学意义(P＞0.05).结论术后放化疗能够提高淋巴结阳性胸段食管鳞癌患者的生存率,毒副反应可耐受.
목적 탐토림파결양성흉단식관린암술후방화료적개치.방법 대수정치료행흉단식관린암삼야림파결청소근치술、술후병리증실유림파결전이、무원처혈행전이적304례흉단식관린암환자진행회고성분석,기중술후방료조140례,술후방화료조164례.술후방료제량50 Gy；화료방안위순박가자삼순,21 d위1개주기.결과 전조환자1、3화5년생존솔분별위90.1％、56.6％화43.3％,중위생존시간위49.7개월.기중술후방화료조화술후방료조환자적5년생존솔분별위47.4％화38.6％,중위생존시간분별위53.5개월화41.7개월(P=0.030).화료1、2、3화4개주기적환자5년생존솔분별위24.4％、53.0％、58.1％화43.3％ (P =0.007).기중화료1개주기여화료2～4개주기적환자5년생존솔비교,차이유통계학의의(P=0.001).단인소분석현시,림파결전이수목、pT분기、치료방법화화료주기수여림파결양성흉단식관린암환자예후유관(균P＜0.05).다인소분석현시,림파결전이수목、pT분기화화료주기수시영향림파결양성흉단식관린암환자예후적독립인소(균P＜0.05).술후방화료조환자적Ⅰ～Ⅱ급중성립세포감소、Ⅰ～Ⅱ급방사성식관염화Ⅰ～Ⅱ급위장도반응적발생솔명현고우술후방료조(균P＜0.05),이만기병발증적발생솔차이무통계학의의(P＞0.05).결론 술후방화료능구제고림파결양성흉단식관린암환자적생존솔,독부반응가내수.
Objective To retrospectively compare the efficacy of postoperative radiotherapy (RT) alone with that of postoperative radiotherapy with concurrent chemotherapy (CRT) for thoracic esophageal squamous cell carcinoma (EPC) with positive lymph nodes,and to evaluate the clinical value of RT + CRT.Methods 304 EPC patients underwent esophagectomy with three-field lymph node dissection had pathological lymph node metastases,but no hematogenous distant metastasis.Among them,140 cases underwent postoperative RT alone,and 164 cases underwent postoperative CRT.The dose of irradiation was 50 Gy,and the chemotherapy regimen was taxol and cis-platinum,and a cycle was 21 days.Results The 1-,3-and 5-year total survival rates of the whole group were 90.1％,56.6％ and 43.3％,respectively,with a median survival time of 49.7 months.The 5-year overall survival rates of the CRT and RT groups were 47.4％ and 38.6％,respectively (P =0.030),with a median survival time of 53.5 and 41.7 months,respectively (P =0.030).The overall survival rates of the patients who underwent 1,2,3,4 cycles of chemotherapy were 24.4％,53.0％,58.1％ and 43.3％,respectively (P =0.007).Among them,the 5-year total survival rate of patients with 2-4 cycles of chemotherapy was significantly better than that of patients who underwent one cycle of chemotherapy (P =0.001).Univariate analysis showed that number of metastatic lymph nodes,pT stage,therapeutic regimen and number of chemotherapy cycles were significantly correlated with the prognosis of the patients (P ＜ 0.05 for all).Multivariate analysis showed that number of metastatic lymph nodes,pT stage,and number of chemotherapy cycles were independent prognostic factors of the patients (P ＜ 0.05 for all).Early toxic effects including neutropenia,radiation esophagitis,and gastrointestinal effects were significantly more severe in the CRT group than that in the RT group (P ＜0.05),however,there were no significant differences of late toxic effects between the two groups (P ＞0.05).Conclusion Postoperative CRT for thoracic EPC with positive lymph nodes can improve the survival rate,with tolerable adverse effects.