新辅助放化疗对中晚期食管鳞癌病理分期及预后的影响

Effects of neoadjuvant radiochemotherapy on pathological stage and prognosis of middle and advanced esophageal carcinoma

目的:评估新辅助放化疗对中晚期食管鳞癌病理分期及预后的影响。方法:1991-01/2000-12中晚期食管鳞癌患者473例,随机分为4组,新辅助放疗组(n= 118)、新辅助化疗组(n=119)、新辅助放化疗组(n=118)及对照组(单纯手术)(n=118),统计分析4组在切除率、病理分期、并发症、生存期等方面的差别结果:放疗组、化疗组、放化组与对照组相比均可提高根治性切除率(97.5%,86.6%,98.3% vs 73.7%,均P<0.01);放疗组、放化组与对照组相比有明显降期作用(P<0.01);而化疗组没有明显降期作用.放疗组、化疗组、放化组与对照组相比,手术并发症无明显增加(P>0.05),放疗组、放化组的3a生存率相比对照组显著提高(69.5%,73.7% vs 53.4%,均P<0.01).放化组的5a生存率优于放疗组,但无统计学意义(45.O% vs 40.7%,P>0.05).结论:合理应用新辅助放化疗可提高中晚期食管鳞癌患者生存期并提高其生存质量.

AIM： To evaluate the effects of neoadjuvant radiochemotherapy on the pathological stage and prognosis of middle and advanced esophageal carcinoma. METHODS： Between January 1991 and December 2000, 473 patients with middle and advanced esophageal carcinoma were randomly divided into four groups; neoadjuvant radiotherapy （n = 118）, neoadjuvant chemotherapy （n = 119）, neoadjuvant radiochemotherapy （n = 118） and control （surgery alone） （n = 118）. The differences in resection rates, pathological stage, treatmentrelated complications and survival rates were statistically analyzed RESULTS： The data showed that the radical resection rate for patients in the radiotherapy, chemotherapy and radiochemotherapy groups was increased compared with that of the control group （97.5%, 86.6% and 98.3% vs 73.7%, all P 〈 0.01）. The pathological stages of the radiotherapy and radiochemotherapy groups were more significantly regressed than that of the control group （P 〈 0.01）. The chemotherapy group did not show the same effect. Treatment-related complications of the three neoadjuvant groups showed no significant difference from that of the control group （P 〉 0.05）. The 3-year survival rates of the radiotherapy and radiochemother- apy groups were significantly higher than that of the control group （69.5% and 73.7% vs 53.4%, both P 〈 0.01）. The 5-yr survival rate of the radiochemotherapy group was higher than that of the radiotherapy group, but did not demonstrate statistical significance （45.0% vs 40.7%, P 〉 0.05）. CONCLUSION： The rational application of neoadjuvant radiochemotherapy appears to provide a modest survival benefit and to improve the quality of life for patients with middle and advanced esophageal carcinomas.