Ⅲ期胸段食管鳞癌根治术后辅助治疗价值

doi:10.3760/cma.j.issn.1004-4221.2017.01.005

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摘要

目的回顾性分析Ⅲ期胸段食管鳞癌根治术后辅助治疗的价值。方法收集2008—2011年间收治的胸段食管鳞癌根治术后Ⅲ期者395例,其中97例单纯手术、212例术后辅助化疗、86例术后放疗。应用Kaplan-Meier法计算生存率,组间比较行Logrank法检验和单因素分析。结果所有病例均随访满3年,125例随访满5年。全组单纯手术、术后辅助化疗和术后放疗者5年OS分别为17.1%、29.2%和36.4%(P=0.000);术后辅助化疗或放疗均能提高男性、胸中上段癌、术中重度粘连、中高分化鳞癌、Ⅲ_a 和Ⅲ_b期者OS (P=0.000~0.049);无论年龄≤60岁/>60岁、食管病变长度<6 cm/≥6 cm、两野或三野手术、清扫淋巴结<10个/≥10个者,术后放疗均能提高OS (P=0.001~0.047);术后辅助化疗提高年龄≤60岁、病变长度<6 cm和清扫淋巴结<10个者OS (P=0.002~0.049)。单纯手术、术后辅助化疗和术后放疗者5年PFS分别为19.0%、28.8%和36.4%,术后放疗高于单纯手术(P=0.012),尤其男性、年龄≤60岁、胸中上段癌、病变长度≥6 cm、清扫淋巴结<10和≥10个、术中重度粘连、中高分化鳞癌、Ⅲ_a和Ⅲ_b期者(P=0.001~0.042),而术后化疗比单纯手术不提高PFS (P=0.119)。结论 Ⅲ期胸段食管鳞癌根治术后辅助化疗和术后放疗均能提高OS,尤其男性、胸中上段癌、术中重度粘连、中高分化鳞癌、Ⅲ_a和Ⅲ_b期者;术后放疗也能提高PFS,而术后化疗不提高PFS。

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	王玉祥
	杨琼
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	齐战
	何明
	乔学英

关键词 ：食管肿瘤/外科学, 食管肿瘤/放射疗法, 食管肿瘤/化学疗法, 预后

Abstract：

Objective To retrospectively analyze the value of postoperative adjuvant therapy in the treatment of stage Ⅲ thoracic esophageal squamous cell carcinoma (ESCC). Methods From 2008 to 2011,a total of 395 patients with stage Ⅲ thoracic ESCC undergoing radical resection were enrolled as subjects. In those patients.97 received surgery alone (S).212 postoperative adjuvant chemotherapy (POCT),and 86 postoperative radiotherapy (PORT).Comparison of categorical data was made by chi-square test. The survival rates were calculated by the Kaplan-Meier method. The log-rank test was used for between-group comparison and univariate analysis. Results All patients were followed up for at least 3 years.125 cases were followed up for at least 5 years. The 5-year overall survival (OS) rates in patients treated with S,POCT and PORT were 17.1%,29.2% and 36.4%,respectively (P=0.000).POCT and PORT could mainly increased OS in patients of males.upper-and middle-segment,severe ahhesion at surgery.well-or middle-differentiation,stage Ⅲ_aand Ⅲ_b(P=0.000-0.049);whenever ages.tumor lesion,two-/three field esophagectomy.and th e number of removal lymph nodes. PORT could improved OS also (P=0.001-0.047).POCT could also improve OS in patients of ages≤60,tumor lesion<6 cm and removal lymph nodes<10(P=0.002-0.049).The 5-year progression-free survival (PFS) were 19.0% with S,28.8% with POCT,36.4% with PORT,respectively (P=0.012).PORT could improve PFS (P=0.012);especially for patients of males,ages ≤60,upper-and middle segment ESCC,tumor lesion ≥6 cm,severe ahhesion at surgery,removal lymph node<10 and ≥10,well or middle differentiation,stage Ⅲ_a and Ⅲ_b(P=0.001-0.042).But POCT could not increased PFS (P=0.119). Conclusions In the treatment of patients with stage Ⅲ thoracic ESCC undergoing radical resection,both POCT and PORT can improve the OS rate,particularly in patients with stage Ⅲ_a or Ⅲ_b middle and upper thoracic ESCC,severe adhesion formation during surgery.and moderately or well differentiated squamous cell carcinoma. The DFS rate is improved in patients treated with PORT,but not in those treated with POCT.

Key words： Esophageal neoplasms/surgery Esophageal neoplasms/radiotherapy Esophageal neoplasms/chemotherapy Prognosis

收稿日期: 2016-04-14

基金资助:

河北省医学科学研究重点课题(20150759)

通讯作者: 王玉祥,Email:wyxhbw69@163.com

引用本文:

王玉祥,杨琼,邱嵘等. Ⅲ期胸段食管鳞癌根治术后辅助治疗价值[J]. 中华放射肿瘤学杂志, 2017, 26(1): 22-28.

Wang Yuxiang,Yang Qiong,Qiu Rong et al. Value of postoperative adjuvant threapy for patients of stage Ⅲ thoracic esophageal squamous cell carcinoma after radical resection[J]. Chinese Journal of Radiation Oncology, 2017, 26(1): 22-28.

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