术前放疗与术后放疗对中晚期食管癌预后的影响

Effect of pre-and post-operative radiotherapy on the prognosis of patients with advanced esophageal carcinoma

目的比较术前放疗与术后放疗对中晚期食管癌预后的影响。方法 95例中晚期食管癌分为术前放疗(A组,45例)和术后放疗(B组,50例)两组。随访5年,用Kaplan-Merier法计算生存率。结果 A组和B组1年和3年生存率相仿(95.8%vs.90.0%和77.8%vs.62.0%)(P>0.05);A组5年生存率明显大于B组(62.2%vs.34.0%)(P<0.05)。淋巴结阳性的患者5年生存率明显大于淋巴结阴性患者(55.0%vs.15.4%)(P<0.05)。肿瘤长度>5 cm患者5年生存率明显大于≤5 cm患者(66.7%vs.32.2%)(P<0.05)。肿瘤外侵(+)患者5年生存率明显大于外侵(-)患者(52.6%vs.13.0%)(P<0.05)。结论与术后放疗相比,术前放疗能显著的提高中晚期食管癌患者5年生存率。对于肿瘤长度>5 cm、有外侵和有淋巴结转移的中晚期食管癌患者宜常规在根治术前行放射治疗。

Objective To compare the effect of pre-and post-operative radiotherapy on the prognosis of patients with advanced esophageal squamous cell carcinoma.Methods A total of 95 patients with advanced esophageal squamous cell carcinoma were devided into two groups of A（45 cases given preoperative radiotherapy combined with radical resection） and B（50 cases given radiotherapy following radical resection）.The patients were followed up for 5 years and 1-,2-and 5-year survival rates were calculated with Kaplan-Merier methods.Results 1-,2-and 5-year survival rates were 95.8%,77.8%,and 62.2% for group A and 90.0%,62.0%,and 34.0% for group B.The 5-year survival rate was significantly higher in group A than that in group B（P〈0.05）.The 5-year survival rate was higher in the patients with lymph node positive than that without（55.0% vs.15.4%）,with the tumor 5cm than that≤5cm（66.7% vs.32.2%）,with external invasion of tumor than that without（52.6% vs.13.0%）（P〈0.05）.Conclusion Compared to postoperative radiotherapy,preoperative radiotherapy can markedly increase the 5-year survival rate in the patients with advanced esophageal squamous cell carcinoma.It is reasenable to perform radiotherapy before operation in esophageal squamous cell carcinoma patients with lymph node metastasis,tumor longer than 5 cm or external invasion of tumor.