胸中段食管鳞癌Ivor-Lewis手术后肿瘤复发196例临床分析

Recurrence Patterns of Esophageal Cancer after Ivor-Lewis Esophagectomy——a Report of 196 Cases

背景与目的:近半数食管癌患者术后3年内出现肿瘤复发,但肿瘤复发的情况尚不完全清楚。本文旨在分析食管癌Ivor-Lewis手术后肿瘤复发的情况。方法:回顾性分析本院1997～2001年接受Ivor-Lewis手术及胸、腹二野淋巴结清扫治疗的196例胸中段食管鳞癌患者的临床资料,Logistic回归分析判定术后3年内肿瘤复发的危险因素。结果:3年内96例(48.9%)患者肿瘤复发,平均复发时间为12.2个月。局部-区域性复发52例(54.1%),其中41例(78.8%)有纵隔淋巴结转移,仅8例(15.3%)患者单纯颈淋巴结转移,血行转移(包括血行转移伴局部-区域性复发10例)44例(45.8%),以肝、骨和肺转移为主,占88.6%(39/44)。手术后辅助放疗组的患者局部-区域性复发率(23.3%)低于未放疗组者(41.3%)(P<0.05)。Logistic回归分析显示,T3期和N1状态是术后肿瘤复发的危险因素。结论:Ivor-Lewis手术后3年内约1/2的患者肿瘤复发,纵隔淋巴结、肝脏、骨和肺是主要的复发部位。手术后辅助放疗可以减少局部-区域性复发。

BACKGROUND ＆ OBJECTIVE： About one half of the patients with esophageal cancer may recur within 3 years after operation, but the recurrence pattern is still unclear. This study was to investigate the recurrence patterns of esophageal cancer after Ivor-Lewis esophagectomy, METHODS： Clinical data of 196 patients with squamous cell carcinoma of the middle third thoracic esophagus, who underwent Ivor-Lewis esophagectomy with two-field lymph node dissection from Jan. 1997 through Jan. 2001, were reviewed. The risk factors of postoperative recurrence within 3 years were analyzed with Logistic regressive model. RESULTS： Recurrence was recognized in 96 （48.9%） patients within 3 year after operation. The median time to recurrence was 12.2 months. Of the 96 cases of recurrence, 52 （54.1%） were Iocoregional, including 41 cases （78.8%） of mediastinal lymph node metastasis, and 8 cases （15.3%） of single cervical lymph node metastasis; 44 （45.8%） were hematogenous, including 10 cases of Iocoregional-hematogenous recurrence, and mainly located at liver, bone, and lung （39, 88.6%）. The Iocoregional recurrence rate was significantly lower in the patients who received postoperative radiotherapy than in the patients have not received postoperative radiotherapy （23.3% vs. 41.3%, P〈 0.05）. Logistic analysis showed that T3 and N1 tumor were independent risk factors of postoperative tumor recurrence. CONCLUSIONS： About one half of the patients would develop recurrent disease within 3 years after Ivor-Lewis esophagectomy, and most of them were with mediastinal lymph node, liver, bone, or lung metastasis. Postoperative radiotherapy is helpful to control Iocoregional recurrence.