胸段食管癌术后复发模式与放疗靶区的设计

Influence of recurrence pattern of thoracic esophageal carcinoma on the design of radiation field in postoperative radiotherapy

目的:通过分析胸段食管癌术后复发部位的规律,探讨术后预防性照射的靶区设计。方法:对我院2001年4月至2011年4月收治的81例食管癌术后复发患者的临床资料进行回顾性分析,采用2检验分析原发肿瘤部位及术后分期与食管癌术后复发部位的关系。结果:81例食管癌术后复发患者最常见的复发部位依次为吻合口49例(60.49%)、颈部/锁骨上淋巴结20例(24.69%)、1、2区淋巴结18例(22.22%)、残食管/残胃17例(20.99%)、4区淋巴结12例(14.81%)、7区淋巴结11例(13.58%);胸上段、胸中段、胸下段食管癌锁骨上淋巴结复发率分别为28.57%(4/14)、23.40%(11/47)、25.0%(5/20),差异无显著性(2=0.156,P>0.05);胸上段和胸中段食管癌上纵隔淋巴结复发率分别为42.86%(6/14)、40.43%(19/47),差异无显著性(2=0.026,P>0.05),胸下段食管癌上纵隔淋巴结复发率为15.0%(3/20),低于胸中段食管癌(2=4.113,P<0.05);IIA、IIB、III期食管癌术后锁骨上淋巴结复发率分别为9.52%(2/21)、27.27%(6/22)、45.0%(9/20),差异有显著性(2=6.545,P<0.05)。吻合口复发率在不同原发部位食管癌(2=0.097,P>0.05)、不同术后分期食管癌(2=0.355,P>0.05)无明显差异。结论:不同原发肿瘤部位食管癌术后放疗的靶区均应包括锁骨上区及吻合口,胸上段及胸中段食管癌还应包括上纵隔淋巴结。对于术后临床分期为III期的食管癌,锁骨上区是重要的预防照射区域。

Aim：To study the recurrence pattern of thoracic esophageal carcinoma after radical surgery and to design the radiation field in postoperative radiotherapy.Methods： The clinical data of 81 cases of recurrent esophageal cancer patients treated in our hospital from April 2001 to April 2011 were reviewed.A χ2 test was used to analyze the recurrence pattern in different groups.Results： The most common recurrence sites were anastomotic stoma（60.49%）,supraclavicular（24.69%）,group 1 and group 2 lymph nodes（22.22%）,esophageal/gastric remnant（20.99%）,group 4 lymph node（14.81%）,and group 7 lymph node（13.58%）.The rates of supraclavicular lymph node recurrence for the upper,middle,and lower esophagus were 28.57%（4/14）,23.40%（11/47）,and 25.0%（5/20）,the difference was not significant（χ2=0.156,P0.05）.The rates of upper mediastinal lymph node recurrence for the upper,and middle esophagus were 42.86%（6/14）,and 40.43%（19/47）,respectively.The difference was not significant（χ2=0.026,P0.05）.The rate of upper mediastinal lymph node recurrence for the lower esophagus was 15.0%（3/20） and lower than that of middle esophagus（χ2=6.545,P0.05）.The rates of supraclavicular lymph node recurrence for the stage IIA,IIB,and III esophageal carcinoma were 9.52%（2/21）,27.27%（6/22）,and 45.0%（9/20）,the difference was significant（χ2=6.545,P0.05）.No difference in the rates of anastomotic stoma recurrence was observed in different groups（P0.05）.Conclusion：The radiation field in postoperative radiotherapy for esophageal carcinoma from different sites should include supraclavicular and anastomotic stoma.For esophageal carcinoma from upper,and middle esophagus,upper mediastinal should also be included.Preventive irradiation to supraclavicular region is especially important for stage III esophageal carcinoma.