放射治疗食管癌穿孔预后因素的分析

Prognostic factors of radiotherapy for perforated esophageal carcinoma(PEC)

目的分析食管癌穿孔后生存时间的影响因素，提出未经治疗的食管癌穿孔后放疗的适应证。材料与方法确定穿孔的标准及研究对象。对１９５８～１９９３年１２月在我院诊为食管癌穿孔的２７７例进行回顾性分析。结果食管癌穿孔后生存时间的影响因素：（１）穿入部位：穿入纵隔、气管、大血管３月内的死亡率分别为５０．７％、６９．９％、１００．０％，Ｐ＜０．０１。（２）穿孔性质：癌性穿孔５９．６％（１６５／２７７），非癌性穿孔（放疗后无癌性穿孔）８．７％（２４／２７７），不能肯定穿孔性质３１．８％（８８／２７７）。临床诊断为非癌性穿孔的１，３，５年生存率分别为９３．８％（１５／１６）、６８．８％（１１／１６）、４２．９％（６／１４）。癌性穿孔均在１年内死亡。（３）非抗癌保守治疗：非抗癌保守治疗组与未做任何处理组比，在癌性穿孔中未显示优势，中位生存期分别为３月，２月；而在非癌性穿孔中，非抗癌保守治疗的中位生存期明显比未做处理组长，分别为５５月，２月。未治疗食管癌穿孔后放疗１３例，ＤＴ５０～７０Ｇｙ７例，平均生存为１０．６月，１年生存３／７例（４２．８％），未放疗１７例，均在半年内死亡。结论（１）食管癌穿孔后生存时间的影响因素主要为穿入部位?

Purpose To define the indications of radiotherapy for untreated but perforated esophageal carcinoma.Materials and Methods Retrospective analysis of 277 PEC patients was carried out from 1958 through 1993 .Results Factors affecting the survival time of PEC patients were:(1) Sites of perforationdeath rates within three months in relation to perforation sites :mediastinum 50.7%,trachea 69.9% and large blood vessel 100%(P<0.01).(2)Nature of perforation:cancerous perforations 59.6%, noncancerous perforations 8.7% and undertermined 31.8%;The 1,3 and 5year survival rates of the noncancerous perforation were 93.8%,68.8% and 42.9% respectivery,whereas all those who developed cancerous perforation died within one year. (3)Nonanticancer conservative treatment:comparision of the result non anti-cancer conservative treatment group with those of the untreated group showed that there was no advantage in the incidence of cancerous perforation. The median survival time of these two groups were 3 and 2 months respectively. The median survival time of these group patients diagnosed clinically as noncancer perforation were 55 and 2 months with obvious superiority in the former.Conclusion (1)The prognostic factors of perforated esophageal carcinoma are: the perforated site,nature of perforation .(2) It is very important that antiinfection treatment be given to patients with noncancerous perforation.(3) The untreated PEC patients should be treated by radiotherapy with a dose of DT≥50Gy.