ⅡA期食管鳞癌Mucin1mRNA表达阳性患者经Ivor-Lewis术后辅助放疗的临床意义

The clinical significance of adjuvant radiotherapy in Mucin1 mRNA-positive patients following Ivor-Lewis esophagectomy in esophageal cancer

目的 探索辅助放疗对Ivor-Lewis手术后ⅡA期食管鳞癌的远期临床效果并评价其预后意义.方法 113例ⅡA期食管鳞癌Ivor-Lewis手术后患者,手术后淋巴结标本检测,Mucin1 mRNA阳性组,手术后行辅助放疗组（试验组）,Mucin1 mRNA阴性组,在肿瘤复发之前不行放疗和化疗（对照组）.照射剂量54～ 60 Gy,27～ 30次,5～6周.照射范围为下颈、锁骨上和上纵隔（包括上段食管旁、气管旁）.应用x2检验比较患者的生存差异;Kaplan-Meier法计算生存率及复发率,采用logistic多因素回归分析独立的危险因素.结果 试验组放射区淋巴结转移率16.7％,对照组该区域淋巴结转移率45.8％,两组差异有统计学意义（P＜0.05）.Mucin1 mRNA阳性患者中,未行术后辅助放疗的患者淋巴结转移率为60.0％,两者差异有统计学意义（P＜0.01）.Logistic多因素回归分析结果显示,肿瘤的T分期和手术后辅助放疗是患者手术后3年内淋巴结转移性复发的独立危险因素.结论 Ivor-Lewis手术联合辅助放疗可显著降低Mucin1基因阳性患者射野区内的淋巴结转移的概率.

Objective To investigate whether Ivor-Lewis esophagectomy combined with adjuvant radiotherapy prevents lymphatic metastatic recurrence in esophageal cancer patients.Methods 113 Stage Ⅱ A esophageal squamous cell carcinoma patients after Ivor-Lewis esophagectomy were accpected mRNA expression of Mucin1 gene detection.Positive patients were enrolled into adjuvant radiotherapy group（with postoperative adjuvant radiotherapy）.Negative patients were enrolled into control group （without postoperative adjuvant radiotherapy or chemotherapy）.The radiotherapy area consisted of the neck,supraclavicular region and the superior mediastinum（including praesophageal and pratracheal region）.Survival difference was compared by x2 test,the Kaplan-Meier method was performed to calculate the survival rate and recurrence rate.Logistic regressive analysis was performed to determined independent risk factors.Results The radiotherapy area lymphatic metastatic recurrence rate in adjuvant radiotherapy group（16.7％,5/30） was lower than patients without postoperative adjuvant radiotherapy （45.8％,38/83） （P ＜ 0.05）.Only compared to positive patients without postoperative adjuvant radiotherapy（60.0％,6/10）,the rate （16.7％,5/30） was significantly lower（P ＜ 0.01）.Cancer recurrence was recognized in 48.6％ （55/113） patients within 3 year after operation,including 38.1％ （43/113） patients with radiotherapy area recurrence.In logistic analysis the T status （P＜ 0.01） and adjuvant radiotherapy （P ＜ 0.05） were independent risk factors of lymph node metastasis in the first 3 years after operation.Conclusion In Mucin1 mRNA-positive esophageal squamous cell carcinoma patients,adjuvant radiotherapy could significantly reduce the lymph node metastasis rate in the radiotherapy area after Ivor-Lewis esophagectomy.Compared with traditional therapeutic methods,Ivor-Lewis esophagectomy combined with adjuvant radiotherapy can achieve similar curative effects in Mucin1 mRNA-positive patients.