55岁以上淋巴结阳性食管癌术后的预后因素及放疗价值

Clinical study of the prognostic factors and the value of three-field lymphadenectomy in esophageal squamous cell carcinoma with positive lymph nodes in the patients(over 55-years old)

目的淋巴结阳性55岁以上食管癌患者术后放疗能否提高生存率和局部控制率少有报道,分析55岁以上淋巴结阳性食管癌三野根治术后的预后因素,评价55岁以上胸段食管鳞癌患者术后放疗价值,为临床制定治疗方案提供理论依据。方法选择1993年1月～2007年3月该院收治的55岁以上淋巴结转移阳性胸段食管鳞癌三野根治术患者469例,其中单纯手术318例,术后放疗151例。术后3～4周开始放疗,中位总剂量50 Gy,分25次,2 Gy/次,5次/周,5周完成。结果全组1、3、5年生存率分别为79.3%、44.2%、27.0%,中位生存时间30.5个月。单因素分析与预后有关的因素有X线病变长度、淋巴结转移个数、pT分期以及术后放疗,多因素分析显示淋巴结转移个数和术后放疗是影响预后的独立因素。结论术后放疗能提高淋巴结转移阳性55岁以上胸段食管鳞癌患者三野根治术后患者的生存率。

Aim There were few reports about the survivals and the local control rates of the postoperative radiotherapy in the patients（over 55-years old）of esophageal squamous cell carcinoma（ESCC） with positive lymph nodes.To analyze the prognostic factors and to evaluate the value of three-field lymphadenectomy in ESCC with positive lymph nodes in the patients.Then to provide the theoretical bases for the therapeutic regimen in the senile patients with ESCC.Methods From July 1993 to March 2007,469 patients were enrolled in this study after three-field lymphadenectomy in ESCC with positive lymph nodes.Among them,318 patients received surgery（three-field lymphadenectomy） alone,151 patients received surgery followed by postoperative radiotherapy.Radiotherapy started within 3 to 4 weeks after surgery.The median total dose was 50 Gy（2 Gy/Fraction,25 fractions,completed in 5 weeks）.Results The 1,3,and 5-year survival rates were 79.3%,44.2% and 27.0% respectively.The median survival time was 30.5 months.With univariate analysis,the prognostic factors included lesion lengths of X-ray barium meal,numbers of metastatic lymph nodes,pT stage and postoperative radiotherapy.With multiplicity,numbers of metastatic lymph nodes and postoperative radiotherapy were independent prognostic factors.Conclusions Postoperative radiotherapy can improve the survival rates of the senile patients of ESCC with positive lymph nodes followed three-field lymphadenectomy.