肿瘤浸润淋巴细胞对食管鳞癌术后辅助化疗的影响

The Influence of Tumor Lnfiltrating Lymphocytes to Postoperative Adjuvant Chemotherapy in Esophogeal Squamous Cell Carcinoma

目的 :探讨肿瘤浸润淋巴细胞对食管鳞癌术后辅助化疗的影响。方法 :97例食管鳞癌患者根治术后随机分为辅助化疗组 (顺铂加 5-氟脲嘧啶 )和单纯手术组。比较两组患者生存率 ,分析肿瘤淋巴细胞浸润与辅助化疗患者生存期的关系。结果 :辅助化疗组 2年、5年生存率 ( 74 0 3%、2 6 9% )低于单纯手术组 ( 82 0 2 %、4 9 6% ,P <0 0 5)。辅助化疗组生存期与肿瘤的生长方式、炎细胞浸润程度、淋巴结转移率和TNM分期有关 (P <0 .0 5)。特别是肿瘤 <3cm、分化程度Ⅰ级、膨胀型生长、无淋巴结转移或Ⅰ +ⅡA期时 ,肿瘤间质常伴有明显炎细胞浸润 ,辅助化疗组与单纯手术组相比患者生存率降低更为明显 (P <0 .0 5)。反之 ,淋巴结转移率 >50 %和Ⅳ期患者肿瘤间质缺乏炎细胞浸润 ,辅助化疗组 2年生存率与单纯手术组比较分别提高于 2 2 2 2 %和 37 50 % (P <0 0 5)。两组其他参数相比生存率无明显差异 (P >0 0 5)。结论 :肿瘤浸润淋巴细胞是影响辅助化疗和预后的一个重要因素 。

Objective:To evaluate the influences of tumor infiltrating lymphocytes (TIL) to postoperative adjuvant chemotherapy in esophogeal squamous cell carcinoma (ESCC).Methods:97 patients with ESCC undergone radical surgery were randomized into adjuvant chemotherapy group(cisplatin plus 5 fluorouracil) and srugical treatment group alone.The survival rate was compared with each of group and the relationship betwween TIL and survival in the patients with adjuvant chemotherapy was analyzed.Results:The 2 and 5 year survival rate was 74.03% and 26.90% in chemotherapy group,and 82.08% and 49.56% in surgery group,respectively.The difference between the two groups was statistically significant ( P <0.05).Significant influential factors in chemotherapy group were the pattern of invasion,degree of lymphocytic infiltration,rate of nodal metastasis and TNM stage ( P <0.01).Especially in tumor size<3 cm,grade Ⅰ,expansive growth,nodal metastasis and stage Ⅰ+ⅡA,withal they showed apparent lymphocytic infiltration in the stroma of primary tumors,the survival of the chemotherapy group was more lower than that of the surgery group ( P <0.05).The patients with nodal metastatic rate>50% or stage Ⅳ,the 2 year survival rate was increased 22.22% and 37 50% in the adjuvant chemotherapy group compared with the surgery group ( P <0.05,respectively).Conclusions:The tumor lymphocytic infiltration in ESCC is one of significant factors influencing the adjuvant chemotherapy and prognosis, and may also provide a useful indicator for selecting patients who could benefit from adjuvant chemotherapy after radical surgery.