合并淋巴结转移的胸段食管鳞癌的术后放化疗效果观察

Value of Postoperative Radiochemotherapy for Thoracic Esophageal Squamous Cell Carcinoma with Lymph Node Metastasis

目的探讨术后放化疗在合并淋巴结转移的胸段食管鳞癌治疗中的效果。方法回顾性分析152例行淋巴结清扫根治术、术后病理证实存在淋巴结转移、但无血行转移的胸段食管鳞癌患者的资料。术后行放化疗82例,术后仅行放疗70例,分别设为A组和B组。术后化疗采用顺铂加紫杉醇方案,1个周期21天;放疗剂量50~60 Gy。观察2组患者1、3和5年生存率,中位生存时间。结果 2组患者1、3年生存率的差异无统计学意义(P>0.05),但5年生存率差异有统计学意义(P<0.05)。A组中位生存时间为54.6个月,B组中位生存时间为40.6个月,差异有统计学意义(P<0.05)。在5年生存率方面化疗2~4个周期与化疗1个周期的患者差异明显(P<0.05),化疗2~4个周期的患者之间比较,无统计学差异(P<0.05)。单因素分析显示治疗方法和化疗周期数与患者预后有关(P<0.05),多因素分析显示化疗周期数是影响患者预后的独立因素。A组患者的Ⅰ~Ⅱ级胃肠管反应、Ⅰ~Ⅱ级放射性食管炎和Ⅰ~Ⅱ级中性粒细胞减少的发生率明显低于B组,差异均有统计学意义(P<0.05);而2组患者术后晚期并发症的发生率无统计学差异(P>0.05)。结论术后放化疗能够提高淋巴结阳性胸段食管鳞癌患者的生存率,不良反应可耐受。

Objective To study the efficacy postoperative radiochemotherapy for thoracic esophageal squamous cell carcinoma( EPC) with lymph node metastasis. Methods Clinical data of 152 EPC patients underwent esophagectomy with lymph node dissection,had pathological lymph node metastases,but no hematogenous distant metastasis were retrospectively analyzed. Among them,70 cases underwent postoperative radiotherapy( RT) alone,and 82 cases underwent postoperative radiotherapy with concurrent chemotherapy( CRT). The dose of irradiation was 50 ~ 60 Gy,and the chemotherapy regimen was taxol and cisplatinum,and a cycle was 21 days. 1-,3-and 5-year survival rates,and median survival of the 2 groups were compared. Results The1-,3-year survival rates of the 2 groups had no significant difference( P > 0. 05). The 5-year survival rates of the CRT and RT groups were 48. 4% and 37. 9%,respectively( P < 0. 05),with a median survival time of 54. 6 and 40. 6 months,respectively( P <0. 05). Among them,the 5-year total survival rate of patients with 2 ~ 4 cycles of chemotherapy was significantly better than that of patients who underwent 1 cycle of chemotherapy( P < 0. 05). Univariate analysis showed that therapeutic regimen and number of chemotherapy cycles were significantly correlated with the prognosis of the patients( P < 0. 05). Multivariate analysis showed that number of chemotherapy cycles was the independent prognostic factors of the patients( P < 0. 05). Early toxic effects including neutropenia,radiation esophagitis,and gastrointestinal effects were significantly more severe in the CRT group than that of the RT group( P < 0. 05),however,there were no significant differences of late toxic effects between the 2 groups( P > 0. 05). Conclusion Postoperative CRT for thoracic EPC with positive lymph nodes can improve the survival rate,with tolerable adverse effects.