147例食管癌手术后放疗与化疗的疗效观察

Clinical Observation of Postoperative Radiotherapy and Chemotherapy for 147 Patients with Esophageal Carcinoma

目的:观察胸段食管癌根治术后放疗与化疗对患者生存期、生存率的影响,分析手术损伤对术后放疗、化疗疗效的影响。方法:对2002年1月～2008年11月河南省新乡医学院第一附属医院147例胸段食管癌手术病例随机分组,选择年龄、性别、临床病理分期3个特征,进行放疗或化疗。放疗组放射源为15MV-X线,照射野以术前肿瘤位置为中心全纵隔,常规放疗40Gy;化疗组:5-FU 500mg/m^2,d_(1-5);DDP 70mg/m^2分5次,d_(1-5),每个周期间隔4周,共4～6个周期。经统计学检验,两组病例基本资料无显著性差异,具有可比性。结果:两组病例均以胸内淋巴结转移为主要转移方式。放疗组1、3、5年生存率分别为83.78%、63.51%、41.89%;化疗组1、3、5年生存率分别为69.86%、54.79%、21.92%;两组患者生存率均随病理分期加重而下降;放疗组胸内转移率即纵隔与胸椎转移率为17.56%,化疗组胸内转移率即纵隔与胸椎转移率为38.36%。化疗组血行转移率(5.48%)明显低于放疗组(12.16%);放疗组5年生存率及淋巴结胸内转移率明显优于化疗组,两组差异具有显著性(P<0.01)。结论:胸段食管癌根治术后放疗效果明显好于术后化疗,可以降低胸内淋巴结转移率,延长患者生存期,提高生存率。

Objective： To observe the effects of radiotherapy and chemotherapy on the survival time and survival rate after radical resection of thoracic esophageal carcinoma and to analyze the incidental effects of surgery on the efficacy of postoperative radiotherapy and chemotherapy. Methods： A total of 147 patients with carcinoma of the thoracic esophagus treated with surgery in our hospital between January 2002 and December 2008 were randomly divided into two groups based on treatment. Patients in the radiotherapy group were treated with conventional radiotherapy （40Gy） （15MV-X-ray radioactive source and center-wide mediastinum radiation field）. Patients in the chemotherapy group were treated with 5-Fu （500mg/m^2） d1-5; DDP （70mg/m^2） sub-5 times, d1-5 every week after four weeks, for 4-6 cycles. Results： In both groups, lymph node metastasis was the main type of metastasis. The 1-, 3-, and 5-year survival rates of patients treated with radiotherapy were 83.78%, 63.51%, and 41.89%, respectively. The 1-, 3-, and 5-year survival rates of patients treated with chemotherapy were 69.86%, 54.79%, and 21.92%, respectively. The survival rates of patients in both groups decreased as pathological stage increased. The intrathoracic metastasis rate was 17.56% in the radiotherapy group and 38.36% in the chemotherapy group. The hematogenous metastasis rate in the chemotherapy group （5.48%） was significantly lower than that in the radiotherapy group （12.16%）. The 5-year survival rate in the radiotherapy group was significantly higher than that in the chemotherapy group, with a significant difference （P〈0.01）. Conclusion： The effect of radiotherapy after radical resection of thoracic esophageal carcinoma is significantly better than that of chemotherapy. Radiotherapy can reduce the rate of intrathoracic lymph node metastasis and improve patient survival. Incidental damage from surgery of intrinsic tumor blood vessels and lymphatic vessels can reduce the effects of the chemotherapy drugs.