不同部位食管癌根治性放疗的疗效分析

Effects of radical radiotherapy on different sites of cervical, upper-thoracic, middle-thoracic and lower-thoracic esophageal carcinoma

目的分析不同部位食管癌根治性放疗的疗效差异、可能原因及其预后影响因素。方法选取2009年5月至2012年5月在郑州大学附属肿瘤医院首程接受根治性放疗的191例食管癌患者，病变位于颈段10例、胸上段59例、胸中段101例、胸下段21例。全组放疗处方剂量为40～70Gy（中位数61．51Gy）。对组间资料行卡方检验，用Kaplan-Meier法计算生存率及局控率，Logrank法单因素预后分析，Cox法多因素预后分析。结果随访率为99．5％，随访时间满2年者61例，满3年者24例。颈段、胸上段、胸中段、胸下段食管癌的1、2、3年生存率分别为80．0％、70．0％、30．％，79．7％、47．4％、44．2％，61．4％、27．5％、22．0％，61．9％、25．3％、16．7％，中位生存期分别为26、24、14、13个月（χ2=7．881，P=0．049）。颈段与胸上段相似（χ2=1．359，P=0．244），胸中段与胸下段相似（χ2〈0．01，P=0．990）。颈段高于胸中、下段（χ2=11．342、8．478，P=0．005、0．009），胸上段亦高于胸中、下段（χ2=6．772、12．534，P=0．010、0．001）。颈段与胸上段合并，胸中段与胸下段合并后数据显示两组生存率比较差异有统计学意义（χ2=6．701，P=0．010），胸中、下段癌组与颈、胸上段癌组相比，年龄较大（t=-2．041，P=0．043），病变较长（t=-2．789，P=0．006），肿瘤最大直径较大（t=3．368，P=0．001）。结论颈段、胸上段食管癌患者根治性放疗疗效优于胸中、下段食管癌患者。

Objective To investigate the effects of radical radiotherapy on cervical, upper-tho- racic, middle-thoracic and lower-thoracic esophageal carcinoma. Methods From May 2009 to May 2012, 191 patients with esophageal carcinoma received radical radiotherapy. Among all the patients, 10 patients had cervical EC, 59 patients had upper-thoracic EC, 101 patients had middle-thoracic ECa, 21 patients had lower-thoracic EC. The prescribed dose ranged from 40 Gy to 70 Gy（ median value of 61.51 Gy）. The independent samples t test was used for comparison among groups. The local control rate and survival rate were calculated by Kaplan-Meier method. Logrank method was used for univariare analysis. Cox regression model wes used for multivariate analysis. Results The follow-up rate was 99.5%. The number of patients with 2 years time follow-up was 61, with 3 years was 24. The 1 - ,2 - ,3 - year survival retes of the cervical EC, upper-thoracic EC, middle-thoracic EC and lower-thoracic EC was 80. 0%, 70.0%, 30. % ;79.7% ,47.4% ,44. 2% ;61.4%, 27, 5%, 22. 0% ;61.9%, 25.3%, 16.7%, respectively. The midian survival time was 26,24,14,13 months respectively （χ2 = 7. 881, P = 0. 049）. There were no significant differences in survival rate between the cervical EC cases and upper-thoracic EC cases （χ2 = 1. 359 ,P = 0. 244） , and between the middle-thoracic EC cases and lower-thoracic EC cases （χ2 〈 0.01 ,P =0. 990）. But the cervical EC cases showed significantly higher survival rate than the middlethoracic EC case and lower-thoracic EC cases （ χ2 = 11. 342,8. 478, P = 0. 005,0. 009）, and the upperthoracic EC cases was higher than the middle-thoracic EC case and lower-thoracic EC cases also （χ2 = 6. 772,12. 534,P =0. 010,0. 001 ）. The patients with cervical EC and upper-thoracic EC showed signifi-cantly higher survival rate than those with middle-thoracic EC and lower-thoracic EC （χ2= 6. 701, P = 0.010）. Compared with those cervical EC and upper-thoracic EC, the middle-thoracic EC and lower-thoracic EC showed significantly older age （ t = - 2. 041, P = 0. 043 ）, larger lesion length （ t = - 2. 789, P = 0. 006 ） and larger tumor diam（t = -3. 368,P = 0. 001 ）. Conclusions The therapeutic effect of radical radiotherapy on the patients with cervical EC and upper-thoracic EC is better than that on those with middlethoracic EC and lower-thoracic EC.