淋巴结因素对食管癌术后放疗疗效的影响

Influence of lymph node factors on postoperative radiation efficacy in patients with esophageal cancer

目的探讨食管癌淋巴结因素对术后采用三维适形预防性放疗疗效的影响。方法2006年1月—2010年12月156例食管癌根治术后患者在本院肿瘤放射治疗科行预防性三维适形放疗，95％PTV，DT：50—60Gy／25—30次，如切缘阳性或纵隔内淋巴结最短径〉0．8cm，则局部加量至60Gy。结果全组1、3、5年总体生存率分别为88．5％、57．1％和46．0％，中位生存期为49．08个月。淋巴结阳性组和阴性组1、3、5年生存率分别为82．3％、47．8％、41．1％和94．8％、66．9％、50．8％（P=0．049）。淋巴结转移数1～2枚组和3枚以上组1、3、5年生存率分别为88．3％、51．7％、42．7％和63．2％、35．5％、35．5％（P=0．028）。淋巴结转移率≤0．15组和〉0．15组1、3、5年生存率分别为93．0％、65．0％、50．3％和75．6％、35．6％、32．4％（P=0．036）。结论术后淋巴结转移个数、转移率均对食管癌术后预防性照射患者的生存率有显著影响。淋巴结转移数目越多，生存率越差，应进一步探讨同步放化疗在食管癌术后高危患者中价值。

Objective： To explore the influence of lymph node factors on postoperative radiation efficacy in patients with esophageal cancer. Methods 156 patients with esophageal cancer operation were treated with three dimensional conformal radiotherapy. 95% PTV = DT： 50 to 60 Gy/25 to 30 fx. If shortest diameter of the mediastinal lymph node was greater than 0.8 cm or the margin was positive, then radiation dose increased to 60 Gy. Results The 1, 3 and 5 years overall survival rates of 156 esophageal cancer patients with postoperative radiotherapy were 88.5% , 57.1% and 46.0% respectively. The median survival time was 49.08 months. The 1, 3 and 5 years survival rates of lymph nodepositive group and lymph node negative group were 8 2.3 % , 4 7. 8 % , 41 . 1% and 9 4.8 % , 66.9% ,50.8% respectively（P=0.049）. The 1, 3 and 5 years survival rates of one to two positive nodes group and three or more positive lymph nodes group were 88.3% ,51.7% ,42.7% and 63.2%, 35.5% ,35.5% respectively（ P = 0.028 ）. The 1, 3, 5 years survival rate of lymph node metastasis rate ≤ 0.15 group and 〉0.15 group were 93.0% , 65.0% , 50.3% and 75.6% , 35.6% , 32.4% respectively（P = 0.036）. Conclusion The numbers of lymph node metastasis and lymph node metastasis rate show a significant influencing on survival rate of esophageal cancer patient with prophylactic irradiation. The larger the number of lymph node metastasis is, the lower the survival rate is. Value of concurrent chemoradiotherapy in high-risk postoperative esophageal cancer patients should be explored further.