长段食管癌术前化疗的疗效判定

Evaluation of the clinical efficacy of preoperative chemotherapy in treatment of long esophageal cancer

目的 :评价长段食管癌术前化疗的疗效。方法 :在过去的十七年里 ,我们手术治疗了食管贲门癌 2 110例 ,其中 192例长段食管癌在术前化疗后 2周接受手术 ,化疗方案为顺铂 (2 0mg连用5d)、5 -氟脲嘧啶 (75 0mg～ 10 0 0mg连用 5d)。切除标本常规作病理检查 ,观察临床病理学改变并根据镜下所见划定四级化疗反应。结果 :在 15 9例被切除的标本中 ,我们发现 10 9例 (6 9% )有癌性溃疡边缘变平变矮及肿瘤缩小现象、6 7例 (4 2 % )有间质内炎性细胞浸润、10 2例 (6 4% )有癌细胞凋亡现象。结论 :长段食管癌术前化疗有助于提高其治疗效果。在评价术前化疗的疗效时应考虑其临床病理学改变。

Objective:To evaluate the clinical efficacy of preoperative (neoadjuvant) chemotherapy in treatment of long esophageal cancer. Methods : Over the past 17 years, 2110 patients were treated by surgery for cancer of the esophagus or esophagogastric junction . Of these, 192 patients who underwent long esophageal cancer received preoperative chemotherapy , including course of cisplatin (20 mg for 5 days) and 5-fluorouracil (750-1000 mg for 5 days),and followed by surgery two weeks after chemotherapy. All postoperative specimens were performed routine pathologic exame. Observations were made on the clinicopathological response. The four levels of chemotherapy response based on the view from microscope. Results: We founded that there were the low and flat on margin of cancerous ulcer with reducing tumour for 109(69%) among 157 resected specimens, inflammatory cell infiltration in interstitial substance for 67(42%) and apoptosis in tumour cells for 102(64%). Conclusion : The results showed that preoperative chemotherapy may have contributed to the improved results in the treatment of esophageal carcinoma. Clinicopathological response should be consider in evaluating effectiveness to preoperative chemotherapy.