胸中段淋巴结阳性食管鳞癌患者术后放化疗生存分析

Survival Analysis of Postoperative Chemoradiotherapy for Patients with Thoracic Middle Segment of Lymph Gland Positive Esophageal Squamous Carcinoma

目的探讨术后放化疗对治疗胸中段淋巴结阳性食管鳞癌患者的临床意义及生存价值。方法回顾性分析2007年1月—2011年12月287例行胸中段食管鳞癌三野淋巴结清扫根治术患者的临床基本资料。根据术后治疗方法的不同分为放疗组133例和放化疗组154例。并对患者1、3、5年的随访资料进行生存分析。结果放化疗组的5年生存率和中位生存时间分别高于放疗组(P<0.05)。单因素分析显示,淋巴结转移数目、p T分期、治疗方法和术后化疗周期与患者1、3、5年生存率有关(P<0.05,P<0.01)。多因素分析显示,淋巴结转移数目、p T分期和术后化疗周期数是影响患者1、3、5年生存率的独立因素(P<0.05,P<0.01)。放化疗组的中性粒细胞减少、早期放疗反应中食管损伤和胃肠道损伤的发生率明显高于放疗组(P<0.05,P<0.01)。结论胸中段淋巴结阳性食管鳞癌术后联合放化疗能有效提高生存率,改善预后,提高生活质量。

Objective To investigate clinical significance and survival value of postoperative chemoradiotherapy for patients with thoracic middle segment of lymph node positive esophageal squamous carcinoma. Methods Clinical da- ta of 287 patients with thoracic middle segment of esophageal squamous cell carcinoma undergoing three-field lymph node dissection during January 2007 and December 2011 was retrospectively analyzed, and the patients were divided into radio- therapy group （n = 133） and chemoradiotherapy group （n = 154） according to different treatment methods after surgery. Survival analysis was performed on the basis of 1st , 3rd and 5th years of follow-up data. Results Values of survival rate and middle survival time in 5th year in chemoradiotherapy group were higher than those in radiotherapy group（ P 〈 0. 05 ）. Single factor analysis showed that number of lymph node metastases, pT staging, treatment method and postoperative chemotherapy cycles were related to survival rates in 1st , 3rd and 5th years （P 〈 0.05, P 〈 0. 01 ）. Multivariate analysis showed that number of lymph node metastases, pT staging and postoperative chemotherapy cycles were independent factors affecting survival rates in 1st, 3rd and 5th ears （P 〈 0. 05, P 〈 0. 01 ）. In chemoradiotherapy group, neutrophilic granulocyte was decreased, and incidence rates of esophageal injury and gastrointestinal injury in early radiotherapy were significantly higher than those in radiotherapy group （P 〈0. 05, P 〈 0. 01 ）. Conclusion Postoperative chemoradiother- apy can effectively improve survival rate, prognosis and life quality of patients with thoracic middle segment of lymph node positive esophageal squamous carcinoma.