胸段食管癌术后预防性照射的预后分析

Prognostic analysis of thoracic esophageal carcinoma treated with postoperative prophylactic radiotherapy

目的 探讨胸段食管癌根治术后预防性照射的范围对长期生存的影响.方法 回顾分析2000-2007年间201例胸段食管癌根治术后行预防性照射患者资料,比较照射范围差异对生存影响,并对可能影响预后的因素行Cox模型多因素分析.Kaplan-Meier法计算OS率,Logrank检验差异.结果 5年随访率为97.0％.全纵隔、全纵隔＋胃左区、全纵隔＋双锁骨上区、中上纵隔＋双锁骨上区、全纵隔＋双锁骨上＋胃左区照射的5年OS率分别为21.7％、37.1％、38.7％、34.8％、19.8％（P =0.406）,多因素分析结果显示仅仅术后N分期为预后影响因素（P =0.009）.预防性照射后锁骨上淋巴结转移11例、中上纵隔淋巴结转移34例、腹腔淋巴结转移10例.结论 胸段食管癌根治术后预防性照射范围应包括中上纵隔和双锁骨上区.

Objective To investigate the effect of the extent of postoperative prophylactic radiotherapy after radical surgery on the long-term survival in patients with thoracic esophageal carcinoma.Methods A retrospective analysis was performed on the clinical data of 201 patients with thoracic esophageal cancer who received postoperative prophylactic radiotherapy after radical surgery from 2000 to 2007.The effect of the extent of radiotherapy on survival was evaluated,and the possible prognostic factors were subjected to multivariate Cox regression analysis.The Kaplan-Meier method was used to calculate overall survival （OS） rates,and the log-rank test was used for survival difference analysis.Results The 5-year follow-up rate was 97.0％.The OS rates for patients who received radiotherapy to the whole mediastinum,whole mediastinum ＋ lymph nodes along the left gastric artery,whole mediastinum ＋ bilateral supraclavicular regions,upper and middle mediastinum ＋ bilateral supraclavicular regions,and whole mediastinum ＋ bilateral supraclavicular regions ＋ lymph nodes along the left gastric artery were 21.7％,37.1％,38.7％,34.8％,and 19.8％,respectively （P =0.406）.Multivariate analysis showed that postoperative N stage was the independent prognostic factor （P =0.009）.After prophylactic irradiation,metastases to the supraclavicular lymph nodes,lymph nodes in the upper and middle mediastinum,and abdominal lymph nodes were observed in 11,34,and 10 patients,respectively.Conclusions The extent of postoperative prophylactic radiotherapy after radical surgery for thoracic esophageal carcinoma only includes upper and middle mediastinum and bilateral supraclavicular regions.