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182例胸段食管癌根治术后残端不典型增生及癌残留治疗模式探讨
王军, 曹峰, 刘青, 程云杰, 王祎, 景绍武, 吴凤鹏, 万欣
050011 石家庄,河北医科大学第四医院放疗科
Treatment modalities in 182 thoracic esophageal cancer patients with atypical hyperplasia in esophageal stump and esophageal stump cancer after esophagectomy
WANG Jun, CAO Feng, LIU Qing, CHENG Yun-jie, WANG Yi, JING Shao-wu, WU Feng-peng, WAN Xin
Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
Abstract：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, 182 thoracic 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 (χ2=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 (χ2=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 (χ2=7.09,P=0.069). For all patients, the 2- and 3-year OS rates were 85% and 74% in thosereceiving RT, 67% and 48% in those receiving CT, 73% and 56% in those receiving RCT, and 44% and 26% in those receiving NT (χ2=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 (χ2=9.89,P=0.020). 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 (χ2=12.34, P=0.006). Conclusions The thoracic EC patients with grade Ⅰ—Ⅱ atypical 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.
WANG Jun,CAO Feng,LIU Qing et al. Treatment modalities in 182 thoracic esophageal cancer patients with atypical hyperplasia in esophageal stump and esophageal stump cancer after esophagectomy[J]. Chinese Journal of Radiation Oncology, 2013, 22(2): 102-107.
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2013, Vol. 22 
