| 朱卫国,陶光州,李涛,等.淋巴结阳性的食管癌患者术后预防性放射治疗的回顾性研究[J].中华放射医学与防护杂志,2011,31(5):571-574.ZHU Wei-guo,TAO Guang-zhou,LI Tao,et al.Effects of postoperative 3-dimensional conformal radiotherapy on lymph node positive patients after radical resection of esophageal carcinoma[J].Chin J Radiol Med Prot,2011,31(5):571-574 |
| 淋巴结阳性的食管癌患者术后预防性放射治疗的回顾性研究 |
| Effects of postoperative 3-dimensional conformal radiotherapy on lymph node positive patients after radical resection of esophageal carcinoma |
| 投稿时间：2011-03-04 |
| DOI：10.3760/cma.j.issn.0254-5098.2011.05.017 |
| 中文关键词: 食管肿瘤 放射疗法 淋巴结 转移 |
| 英文关键词:Esophageal neoplasms Radiotherapy Lymphatic node Metastasis |
| 基金项目: |
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| 摘要点击次数: 4831 |
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| 中文摘要: |
| 目的 回顾性分析淋巴结阳性的食管癌患者术后放射治疗的意义。方法 自1999年9月至2005年10月,选择260例代表不同淋巴结转移状态的食管癌根治性手术切除患者进行研究。其中, 单纯手术组(A组)130例,术后放疗组(B组)130例。根据淋巴结转移的个数分为3个亚组,A1组(无淋巴结转移)42例,A2组(淋巴结转移个数1~3枚)43例,A3组(淋巴结转移个数≥4枚)45例;B1组(无淋巴结转移)43例,B2组(淋巴结转移个数1~3枚)44例,B3组(淋巴结转移个数≥4枚)43例。结果 (1) A和B组的1、3、5年总生存率分别为71.5％、35.4％、20.0％和76.2％、48.5％、36.2％(χ2=7.822,P<0.05)。A1和B1组、A2和B2组及A3和B3组的1、3、5年生存率分别为83.3％、52.3％、38.1％和81.3％、58.1％、46.5％(χ2=0.283,P>0.05),69.8％、34.9％、18.6％和77.3％、47.7％、40.9％(χ2=4.188,P<0.05)及62.2％、20.0％、4.4％和69.8％、39.5％、20.9％(χ2=6.168,P<0.05);B2和B3组生存率分别为40.9％与20.9%(χ2=4.213,P<0.05)。(2)A1和B1组、A2和B2组及A3和B3组的5年累计淋巴结转移率分别为30.9％和11.6％(χ2=4.753,P<0.05),53.4％和22.7％(χ2=8.741,P<0.05)及 66.7％和30.2％(χ2=11.682,P<0.05)。(3)A1和B1组、A2和B2组及A3和B3组的5年血行转移率分别为11.9％和13.9％(χ2=0.079,P>0.05),20.9％和20.4％(χ2=0.003,P>0.05)及31.1％和25.6％(χ2=0.203,P>0.05)。结论 术后放疗可以提高淋巴结阳性患者的生存率,降低放疗部位的淋巴结转移率,血行转移随淋巴结转移数的增加而增加。 |
| 英文摘要: |
| Objective To analyze the significance of postoperative radiotherapy for lymph node positive patients after radical resection of esophageal carcinoma. Methods Two hundred and sixty patients with esophageal squamous cell cancer, aged ≤70, with the performance status score of 0-1, who had undergone radical resection were divided into 2 equal groups: surgery alone group (Group A) and surgery plus radiotherapy group (Group B).Group A was classified into 3 sub-groups:Group A1 ( n=42) without lymph node involvement, Group A2 (n=43) with 1 to 3 involved lymph nodes, and Group A3 (n=45) with ≥4 involved lymph nodes.Group B was classified into 3 sub-groups:Group B1 (n=43) without lymph node involvement, Group B2 (n=44) with 1 to 3 involved lymph nodes, and Group B3 (n=43) with ≥4 involved lymph nodes.The patients were followed up till death. Results The 1-,3-, and 5-year overall survival rates of Group A were 71.5％, 35.4％ and 20％, respectively, all significantly lower than those in Group B (76.2％,48.5％ and 36.2％, respectively, χ2=7.822,P<0.05). The 1-, 3-, and 5-year survival rates of Groups A1 were 83.3％, 52.3％, and 38.1％,respectively, all not significantly different from those of Group B1 (81.3％, 58.1％, and 46.5％,respectively, χ2=0.283,P>0.05). The 1-, 3-, and 5-year survival rates of Groups A2 were 69.8％,34.9％,and 18.6％,respectively, all significantly lower than those of Group B2 (77.3％,47.7％,and 40.9％,respectively, χ2=4.188,P<0.05). The 1-, 3-, and 5-year survival rates of Groups A3 were 62.2％,20％,and 4.4％,respectively, all significantly lower than those of Group B3 (69.8％,39.5％,and 20.9％,respectively, χ2=6.168,P<0.05). The 5-year metastatic lymph node rates of Groups A1 to A3 were 30.9％, 53.4％, and 66.7％,respectively, all significantly higher than those of Groups B1 to B3 (11.6％, 22.7％, and 30.2％,respectively, χ2=4.753,8.741, and 11.682,respectively, all P<0.05). The 5-year distant metastasis rates of Groups A1 to A3 were 11.9％, 20.9％, and 31.1％,respectively, all not significantly different from those of Groups B1 to B3(13.9％,20.4％,and 25.6％,respectively, χ2=0.079,0.003,and 0.203,respectively,all P>0.05). Conclusions Postoperative radiotherapy increases the survival rate of lymph node positive patients, but shows little efficacy on the lymph node negative patients. It reduces the occurrence of lymph node metastasis, even in the lymph node negative patients, and does not increase the morbidity of complications, especially that of anastomotic stenosis. The number of metastatic lymph node is one of the important factors affecting the survival of esophageal carcinoma. Distant metastasis increases along with the number of metastatic lymph nodes. |
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