摘要
目的 评价术后联合放化疗（S＋CRT）或术后放疗（S＋RT）对Ⅱ、Ⅲ期胸段食管鳞癌患者疗效和不良反应.方法 收集2007-2010年间行根治术且术后辅助放疗或放化疗的Ⅱ、Ⅲ期胸段食管鳞癌215例患者资料.Kaplan-Meier法计算生存率并Logrank法检验和单因素预后分析,Cox模型多因素预后分析.结果 S＋CRT与S＋RT组资料具有可比性（P=0.055-0988）.随访满1、3、5年者分别为203、133、108例.全组患者1、3、5年OS和DFS分别为940%、614%、493%和749%、535%、467%.患者术前CT显示纵隔淋巴结肿大、术中食管病变与周边组织器官粘连程度、病理N分期、脉管瘤栓、阳性淋巴结个数和治疗方式均为OS影响因素（P=0.000-0034）,患者术前CT显示纵隔淋巴结肿大、术中食管病变与周边组织器官粘连程度、术后残端是否阳性、阳性淋巴结个数和治疗方式均为DFS影响因素（P=0.000-0049）.S＋CRT组OS、DFS均优于S＋RT组（P=0002、0002）.分层分析显示Ⅱ期患者S＋CRT组OS、DFS均高于S＋RT组（P=0041、0001）;N1期患者S＋CRT组OS、DFS也均高于S＋RT组（P=0021、0024）.S＋CRT组≥2级放射性胃炎及骨髓抑制发生率均高于S＋RT组（P=0000、0015）.结论 Ⅱ、Ⅲ期胸段食管鳞癌术后患者接受S＋CRT及S＋RT均具有较好疗效;S＋CRT较S＋RT能提高Ⅱ期和N1期患者OS与DFS;S＋CRT组不良反应较大但患者均可耐受;但最终结论需前瞻性Ⅲ期随机研究证实.
Objective To evaluate the efficacy and adverse reactions of postoperative chemoradiotherapy （S＋CRT） and postoperative radiotherapy （S＋RT） for stage Ⅱ/Ⅲ thoracic esophageal squamous cell carcinoma. Methods Clinical data were collected from 215 patients with stage Ⅱ/Ⅲthoracic esophageal squamous cell carcinoma who received radical resection and postoperative adjuvant radiotherapy or chemoradiotherapy from 2007 to 2010. Survival rates were calculated by the Kaplan-Meier method and analyzed by the log-rank test. Univariate and multivariate analyses were made by the log-rank test and Cox proportional model, respectively. Results The data were comparable between the S＋CRT group and the S＋RT group （ P=0055-0988） . The numbers of patients who received 1-, 3-, and 5-year follow-up were 203, 133, and 108, respectively. In all the patients, the 1-, 3-, and 5-year overall survival （ OS） rates were 940%, 614%, and 493%, respectively, and the 1-, 3-, and 5-year disease-free survival （ DFS） rates were 749%, 535%, 467%, respectively. Preoperative mediastinal lymph node enlargement on computed tomography （ CT ） , the degree of adhesion of esophageal lesions to peripheral tissues during surgery, pathological N staging, vascular tumor thrombus, the number of positive lymph nodes, and treatment strategy were independent prognostic factors for OS （P=0000-0034）. Preoperative mediastinal lymph node enlargement revealed on CT, the degree of adhesion of esophageal lesions to peripheral tissues＆amp;nbsp;during surgery, incomplete removal of tumor from the esophagus, the number of positive lymph nodes, and treatment strategy were independent prognostic factors for DFS （P=0000-0049）. The S＋CRT group had significantly improved OS and DFS rates than the S＋RT group （ P=0002, 0002） . The result of stratified analysis showed that for the patients with stageⅡdisease and those with stage N1 disease, the S＋CRT group had significantly improved OS and DFS rates than the S＋RT group （ P=
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2017年第3期279-286,共8页
Chinese Journal of Radiation Oncology
关键词
食管肿瘤/外科学
食管肿瘤/术后放疗
食管肿瘤/术后放化疗
预后
Esophageal neoplasms/surgery
Esophageal neoplasms/postoperative radiotherapy
Esophageal neoplasms/postoperative chemoradiotherapy
Prognosis
