145例胸段食管癌术后纵隔淋巴结转移放射治疗的疗效评价

The Effect of Radiotherapy on 145 Cases of Mediastinal Metastasis from Esophageal Carcinoma after Surgery

目的:探讨食管癌术后纵隔淋巴结转移患者放射治疗的疗效及影响预后的因素。方法:回顾性分析1998年1月至2005年12月河北医科大学第四医院收治的胸段食管癌根治术后纵隔淋巴结转移的145例患者临床资料,其中男95例,女50例;中位年龄57岁;术前肿瘤位于胸上段10例,胸中段126例,胸下段9例;肿瘤中位长度4.0cm(2.0～12.0cm)。术后病理鳞癌136例,腺癌6例,小细胞癌3例;残端阴性134例,阳性11例。术后TNM分期Ⅰ期4例,Ⅱa期66例,Ⅱb期27例,Ⅲ期45例,Ⅳ期3例。确诊术后淋巴结转移中位时间12个月(1～121个月),纵隔淋巴结转移115例,纵隔伴锁上淋巴结转移30例。转移淋巴结长径中位长度5cm(1.0～10.7cm),其中≤5cm.92例,>5cm 53例。常规放疗47例,三维适形放疗67例,前程常规加后程适形放疗31例。合并化疗72例,单纯放疗73例。结果:145例患者放疗结束后总有效率(CR+PR)78.6%;中位生存期为12个月,1、2、3年生存率分别为47.1%、20.5%、13.2%。单因素分析显示术前肿瘤部位、术后分期、术后发现纵隔淋巴结转移时间及术后纵隔转移淋巴结长径对预后具有显著影响(P<0.05)。而患者性别、年龄、术后病理、术后残端阳性、合并锁上淋巴结转移、放疗方式、放疗剂量及化疗对预后无关。Cox回归分析显示术后分期、术后纵隔转移淋巴结长径为独立预后影响因子(P<0.05)。放疗后1级放射性胃肠道反应发生率为16.6%(24/145),2级反应发生率为51.0%(74/145),3级反应发生率为32.4%(47/145)。结论:食管癌术后临床分期较早的患者发生纵隔淋巴结转移行放射治疗的预后较好,而纵隔转移淋巴结长径较短者放射治疗后的预后优于较长者。

Objective： To evaluate the effect of radiotherapy on mediastinal metastasis from esophageal carcinoma after surgery. Methods： From January 1998 to December 2005, 145 such cases were treated with postoperative irradiation. Results： The local control rate of all cases was 78.6%. The median survival time was 12 months. The 1-, 2-, and 3-year survival rates of all cases were 47.1%, 20.5%, and 13.2%, respectively. The site of tumor, clinical stage, the time of detection of lymph node metastasis and the length of mediastinal lymph node metastasis affected the prognosis （P〈0.05）. The rates of grade 1, grade 2, and grade 3 side ef- fect of radiation were 16.6% （24/145）, 51.0% （74/145）, and 32.4% （47/145）, respectively. Conclusion： The cases of early clinical stage after radiotherapy have better prognosis than those with late clinical stage. The prognosis of cases with small lymph nodes of mediastinal metastasis was better than those with large ones.