N_0期食管鳞癌三野根治术后放疗价值的临床研究

A Clinical study on the value of postoperative radiotherapy after three-field lymphadenectomy in N_0 esophageal squamous cell carcinoma

目的评价N0期食管鳞癌三野根治术后放疗价值及预后因素分析。方法分析1993年1月至2006年11月我院食管癌患者行下颈、右胸、上腹三野淋巴结清扫根治术，术后病理诊断证实均为鳞癌，无淋巴结转移及远处转移N0期患者756例，其中单纯手术665例，术后放疗91例。术后3～4周开始放疗，照射中位总剂量50Gy，分25次，2Gy做，5次／N，5周完成。结果全组1、3、5、10年生存率分别为93．7％、82．2％、74．1％和65．4％，5年生存率手术组和术后放疗组分别为73．7％和76．8％（Х^2=0．134，P=0．714）。分层分析术后放疗较单纯手术可提高pT4期的5年生存率，分别为81．6％对50．4％（Х^2=3．919，P=0．048），并能降低pY4期瘤床复发率；而对于病变长度≤5cm患者5年生存率反而降低，分别为69．5％和74．3％（Х^2=4．336，P=0．037）；多因素分析显示年龄和Fr分期是影响预后的独立因素。结论术后预防性放疗可明显提高pT4期的生存率和降低—T4期瘤床复发率，年龄和pT分期是影响预后的独立因素。

Objective To evaluate the value of postoperative radiotherapy after three-field lymphadenectomy in No esophageal squamous cell carcinoma and to analyze the prognostic factors. Methods From January 1993 to November 2006, 756 patients with squamous cell carcinoma of the esophageal were enrolled in this study. All patients were staged No pathologically after three- field lymphadenectomy in our hospital. Among them, 665 patients received surgery alone, 91 patients received surgery followed by postoperative radiotherapy. Radiotherapy started within 3 to 4 weeks after surgery. The median total dose was 50Gy （2 Gy/Fraction, 25 fractions, completed in 5 weeks）. Results The 1, 3, 5 and 10 year overall survival rates were 93.7 %, 82.2 %, 74.1% and 65.4 % respectively. The 5 - year survival rates were 73.7 % vs 76.8 % in surgery alone group vs postoperative radiotherapy group （Х^2 = 0. 134, P = 0. 714）. With stratification analysis, for pT4 patients, the 5- year survival rates were 50.4% and 81.6% in surgery alone group vs. postoperative radiotherapy group （Х^2 =3. 919, P = 0. 048）, which was a significant difference; and local recurrence rates of tumor- bed was lower in postoperatve radiotherapy group; but the 5 - year survival rates for lesions （45 cm） were 69.5 % vs 74.3 % in postoperative radiotherapy group vs surgery alone group （Х^2 = 4. 336, P = 0. 037）. With multiplicity analysis, age and pT stage were independent prognostic factors. Conclusions Postoperative radiotherapy can significantly improve survival rate and decrease local recurrence rate for pT4 No patients. And age and pT staging were indepen- dent prognostic factors.