Ivor-Lewis手术后辅助放疗预防食管癌淋巴结转移性复发的疗效评价

Effect of Radiotherapy on Preventing the Recurrence of Lymph Node Metastasis of Esophageal Cancer after Ivor-Lewis Esophagectomy

目的:探讨lvor-Lewis手术后辅助放疗对胸中段食管癌淋巴结转移性复发的预防作用,旨在于提高食管癌手术的局部控制率。方法:回顾1999年6月～2004年6月间山东大学附属省立医院胸外科采用改良Ivor-Lewis手术并胸、腹二野淋巴结清扫治疗366例胸中段食管鳞癌患者的完整临床资料,应用SPSS13.0软件包建立数据库,并进行统计分析,Kaplan-meier法计算复发率;Log-rank检验比较复发率差异;Cox回归分析判定手术后淋巴结转移的独立危险因素。结果:术后3年内,366例患者中105例(28.7%)发生淋巴结转移,占全部复发患者的52.2%(105/201)。181例辅助放疗患者中,37例发生淋巴结转移(20.4%),与单纯化疗和未经系统性辅助治疗患者相比,淋巴结转移率显著降低(P<0.05)。103例单纯化疗患者中,33例发生淋巴结转移(32.0%),低于未经手术后辅助治疗患者的淋巴结转移率,但差异无统计学意义(P=0.17)。Cox回归分析结果显示:肿瘤的T分类、淋巴结转移和手术后辅助放疗是术后淋巴结转移的独立预后因素。结论:改良Ivor-Lewis手术无严重的手术后并发症。术后辅助放疗患者的局部淋巴结转移率显著降低。肿瘤的T分类、淋巴结转移和手术后辅助放疗是术后淋巴结转移的独立预后因素。lvor-Lewis手术辅助术后放疗,是对胸中段食管鳞癌实现预防淋巴结转移性复发的有效候选方法之一。

Objective： To explore the effect of radiotherapy on preventing the recurrence of lymph node metastasis of esophageal cancer after Ivor-Lewis esophagectomy. Methods： Three hundred and sixty-six patients with middle third squamous cell carcinoma of the esophagus were enrolled in this study. All patients underwent Ivor-Lewis esophagectomy with two-field lymph node dissection in our hospital between June 1999 and June 2004. All statistical analyses were performed with SPSS 13.0 statistical software. Kaplan-Meier method was performed to calculate the relapse rate. Log-rank test was performed to compare the relapse rate. Cox regression analysis was performed to identify independent prognostic factors for postoperative lymph node metastasis. Results： Of the 366 cases, lymph node metastasis was found in 105 patients （28.5%） within 3 years after surgery, occupying 52.2% （105/201） of total recurrence. Of the 181 patients treated with postoperative radiotherapy, lymph node metastasis was found in 37 patients. The rate of lymph node metastasis was 20.4%, significantly lower than that in patients treated with chemotherapy alone and those without systemic adjuvant therapy （P〈0.05）. Chemotherapy was administered in 103 cases and lymph node metastasis was found in 33 patients. The rate of lymph node metastasis was 32.0%, lower than that in patients without systemic adjuvant therapy, but without statistical significance （P=0.17）. The results of Cox analysis demonstrated that T stage, lymph node metastasis and postoperative adjuvant radiotherapy were independent prognostic factors. Conclusion： IvorLewis esophagectomy for the middle third thoracic esophageal cancer was a safe surgical procedure. Postoperative radiotherapy is helpful for the control of local recurrence. T stage, lymph node metastasis and postoperative adjuvant radiotherapy are independent prognostic factors. Radio-therapy is helpful for preventing the recurrence of lymph node metastasis of esophageal cancer after Ivor-Lewis esophagectomy.