局部晚期食管鳞癌单纯手术与术后辅助放化疗的临床研究

Effects of postoperative chemoradiotherapy on locally advanced esophageal squamous cell carcinoma

评价局部晚期食管鳞癌单纯手术与术后辅助放化疗的疗效和安全性。方法 分析 2008～2011年收治的术后经病理证实的局部晚期食管鳞癌患者214例，其中单纯手术93例（单纯手术组），术后调强放疗联合替吉奥化疗121例（术后放化疗组），比较两组的不良反应、局部复发率、远处转移率及生存率。结果 单纯手术组和术后放化疗组局部复发率分别为45.37%和27.38%（P＜0.05），远处转移率分别为46.23%和31.65%（P＜0.05）；1年、3年、5年生存率分别为90%、55%、23%和98%、74%、52%（P＜0.05），中位生存期分别为41.7个月和64.6个月（P〈0.05）。术后放化疗组不良反应以1-3级为主，3级主要为白细胞下降、放射性食管炎和咳嗽，晚期不良反应为放射性肺纤维化和吻合口狭窄。结论 局部晚期食管鳞癌根治术后调强放疗联合替吉奥化疗安全、可行，能有效提高生存率。

To evaluate the efficacy of chemoradiotherapy for locally advanced esophageal squamous cell carcinoma. Methods Clinical data were retrospectively analyzed for 214 patients with esophageal cancer who underwent surgery between 2008 and 2011. Rates of local recurrence,distant metastasis and survival were compared between 121 patients who underwent both surgery and postoperative chemoradiotherapy,and 93 patients who underwent surgery alone. Results Patients receiving postoperative chemoradiotherapy showed a significantly lower rate of local recurrence than patients who underwent surgery alone（27.38% vs 45.37%）;a similar result was observed for rate of distant metastasis（31.65% vs 46.23%）（P〈0.05）. Similarly,the postoperative chemoradiotherapy group showed significantly higher overall survival rates at 1 year（98% vs 90%）,3 years（74% vs 55%）,and 5 years（52% vs 23%）. All patients tolerated their treatment well. Most adverse events were grades 1 and 2;grade 3 adverse events were leucopenia,radiation esophagitis,cough,and anastomotic stenosis. Conclusions Postoperative chemoradiotherapy can provide overall survival benefit to patients with locally advanced esophageal squamous cell carcinoma.