T3N1M0 期食管癌术后辅助治疗的临床研究

郝建磊; 徐利明; 侯海玲; 庞青松; 王 平

doi:10.3969/j.issn.1000-8179.2010.20.010

摘要: 目的：探讨T3N1M0 期食管癌术后辅助治疗的疗效。方法：回顾性分析天津医科大学附属肿瘤医院食管癌术后患者，共196 例。其中86例患者仅行食管癌根治术（S 组），52例患者接受了术后化疗（S+C 组），49例患者接受了术后预防照射（S+R 组）。另有9 例患者接受了术后序贯化放疗，因病例数少未予统计分析。对三组患者预后进行比较。使用SPSS15.0 分析统计软件进行数据分析。数值变量采用t 检验，组间比较采用卡方检验，生存率计算采用Kaplan-Meier 法并用Log-rank 检验。结果：S 组、S+C组、S+R 组的1 年生存率分别为：61.6% 、63.5% 、83.7%（P=0.022）；3 年生存率分别为：34.9% 、34.6% 、55.1%（P=0.045）；5 年生存率分别为：12.8% 、15.4% 、34.7%（P=0.006）；无病生存率分别为：10.5% 、11.5% 、28.6%（P=0.003）；锁上淋巴结转移率分别为：20.9% 、23.1% 、6.1%（P=0.030）；胸内淋巴结转移率分别为：31.4% 、25.0% 、16.3%（P=0.155）；血行转移率分别为：24.4% 、21.2% 、22.4%（P=0.902）；吻合口复发率（P=0.247）；吻合口狭窄率（P=0.924）。病理分级影响患者的预后，男性患者预后要差于女性患者。结论：T3N1M0 期食管癌术后放疗能提高患者生存率，降低区域淋巴结引流区的转移率，未能降低血行转移率。化疗（以PF方案为主）对患者的预后影响不大。建议采用新的有效药物治疗。

Abstract: Objective: To study the effect of postoperative adjuvant therapy in stage-T 3N1M0 esophageal cancer patients. Methods:Data from 196 esophageal cancer patients who had undergone surgery in Tianjin Cancer Hospital were retrospectively analyzed. Of these patients, simple radical correction was conducted in 86 (group S), surgery plus postoperative adjuvant therapy occurred in 52 (group S + C), and surgery combined with radiotherapy was done in 49 (group S + R). Data from 9 patients who accepted sequential chemo-radiotherapy were not included in the statistical analysis because of the small number of cases. Prognoses of the three groups were compared. Analysis of data was conducted using SPSS 15.0 statistical software. The t test was used for obtaining numerical variables and chi-square test for the inter-group comparison. Kaplan-Meier method and Log rank test were used for calculating the survival rates. Results: One-year survival rates were 61.6% ,63.5% and 83.7% in the group S, group S + C and group S + R (P=0.022 ), respectively. The 3-year survival rates were 34.9% ,34.6% and 55.1% (P=0.045 ), respectively. The 5-year survival rates were 12.8% ,15.4% and 34.7% (P=0.006 ). For the three groups, the disease-free survival rates were 10.5% ,11.5% and 28.6% , respectively (P= 0.003 ). The rates of supraclavicular lymph metastasis were 20.9% ,23.1% and 6.1% (P=0.030 ), respectively, and the rates of endothoracic nodal metastasis were 31.4%,25.0% and 16.3% (P=0.155 ). The hematogenous metastasis rates were24.4% ,21.2% and 22.4% , respectively (P=0.902 ). The local recurrence rates of the anastomotic stoma were 4.7, 0 and 2.0 (P=0.247 ), and the rates of anastomotic stoma stenosis were 4.7, 5.8 and 6.1 % in the three groups, respectively (P=0.924 ). The prognosis of patients was influenced by the histological grade, which was poorer in the male patients than in the female patients. Conclusion : Radiotherapy can increase the survival rate of T3N1M0 esophageal cancer patients and can decrease the rate of regional lymph node metastasis. However, it cannot decrease the hematogenous metastasis rate. Postoperative chemotherapy (PF regimen, i.e. PDD+5FU) has little effect on prognosis of the patients. A new regimen must be developed and implemented that addresses these issues.

T₃N₁M₀ 期食管癌术后辅助治疗的临床研究

Postoperative Adjuvant Therapy in T₃N₁M₀ Esophageal Cancer Patients