新辅助化放疗联合手术治疗局部晚期食管癌30例

Neoadjuvant chemoradiotherapy combined with surgery in treatment of locally advanced esophageal cancer: a report of 30 cases

目的探讨新辅助化放疗联合手术治疗局部晚期食管癌的安全性及可行性。方法将2013年1月至12月在复旦大学附属肿瘤医院胸外科收治的60例局部晚期食管癌患者随机分为联合治疗组和单手术组,每组30例,联合治疗组行新辅助化放疗联合手术治疗,单手术组单纯行手术治疗。对比两组患者术中、术后的临床资料及预后状况。结果联合治疗组和单手术组的淋巴结转移率分别为26. 67%和53. 33%,淋巴结转移度分别为3. 65%和7. 24%,R0切除率分别为96. 67%和73. 33%,组间比较差异均有统计学意义(P均<0. 05)。两组手术时间、术中出血量、术后住院时间、并发症发生率差异无统计学意义(P均> 0. 05)。联合治疗组和单手术组的中位生存期分别为36个月和13个月,差异有统计学意义(P <0. 05)。结论新辅助化放疗联合手术治疗能够更加彻底的对局部晚期食管癌患者进行根治性治疗,改善患者的生存预后,不增加手术的并发症,提高疗效。

Objective To explore the feasibility and safety of neoadjuvant chemoradiotherapy combined with surgery in the treatment of locally advanced esophageal carcinoma. Methods Sixty patients with locally advanced esophageal carcinoma who received treatment at Fudan University Shanghai Cancer Center from January to December 2013 were randomly divided into combined treatment group and operation alone group（n = 30,each）. The neoadjuvant chemoradiotherapy combined with surgical treatment was performed in combined treatment group,while single surgical treatment was performed in operation alone group. The intraoperative and postoperative clinical features and prognosis were compared between two groups.Results There were significant differences in lymph node metastasis rates（26. 67% vs 53. 33%）,degrees of lymph node metastasis（3. 65% vs 7. 24%） and R0 resection rates（96. 67% vs 73. 33%） between combined treatment group and operation alone group（all P〈0.05）. There were no significant differences in operative time,intraoperative blood loss,postoperative hospitalization time and incidence of complications between two groups（all P〈0.05）. The median survival time of the combined treatment group and the operation alone group was 36 months and 13 months,respectively,and there was significant difference between two groups（P〈0.05）. Conclusions For patients with local advanced esophageal cancer,neoadjuvant chemoradiotherapy combined with surgery can be a more radical treatment and improve the survival status and prognosis without increasing the complications of operation compared with traditional surgery alone. It has a positive role and combined treatment significance in the curative efficacy.