| 张泉,吴清泉,常新,等.胸中段食管鳞癌左胸路径根治性手术后局部区域复发规律的研究[J].中华放射医学与防护杂志,2017,37(9):661-666.Zhang Quan,Wu Qingquan,Chang Xin,et al.The local recurrent pattern of middle thoracic esophageal squamous cell carcinoma after left thoracotomy esophagectomy[J].Chin J Radiol Med Prot,2017,37(9):661-666 |
| 胸中段食管鳞癌左胸路径根治性手术后局部区域复发规律的研究 |
| The local recurrent pattern of middle thoracic esophageal squamous cell carcinoma after left thoracotomy esophagectomy |
| 投稿时间：2017-01-04 |
| DOI：10.3760/cma.j.issn.0254-5098.2017.09.004 |
| 中文关键词: 胸中段 食管鳞癌 左胸路径 局部复发 |
| 英文关键词:Middle thoracic Esophageal squamous cell carcinoma Left thoracotomy Local recurrence |
| 基金项目:上海市科学技术委员会科研项目（15411950105） |
|
| 摘要点击次数: 3605 |
| 全文下载次数: 2823 |
| 中文摘要: |
| 目的 探讨胸中段食管鳞癌左胸路径根治性术后局部复发的规律，为术后放射治疗的靶区设计提供依据。方法 回顾性分析2007年5月至2015年12月收治的752例胸中段食管鳞癌术后局部复发患者的临床资料，分析纵隔、吻合口、腹腔及原瘤床各区域复发的情况。结果 术后局部复发时间为1~106个月，中位时间14.6个月。术后复发率最高的区域为纵隔79.7%，其次为锁骨上29.1%、吻合口7.4%、腹腔4.1%和原瘤床0.7%，5个区域的复发率比较差异有统计学意义（χ2=925.8，P<0.05）。上纵隔淋巴结转移率达74.2%，中纵隔为19.8%，下纵隔为4.8%，3者间比较差异有统计学意义（χ2=791.6，P<0.05）。胸内纵隔淋巴结分区分为1~10区，纵隔转移淋巴结分区中1~5区及7区转移率较高，而6区及8~10区转移率较低，之间差异有统计学意义（χ2=486.9，P<0.05）；上纵隔淋巴结转移主要分布于气管旁区域，其中右气管旁区（1R、2R、4R）总淋巴结转移率为47.1%，左气管旁区（1L、2L、4L）总淋巴结转移率为29.4%，右气管旁淋巴结转移率明显高于左气管旁区（χ2=31.5，P<0.05）。结论 胸中段食管癌术后复发位置主要在双侧锁骨上、上中纵隔、吻合口，建议术后预防放射治疗靶区包括双侧锁骨上区、上纵隔1~5区、中纵隔7区及吻合口区域。 |
| 英文摘要: |
| Objective To study the local recurrent pattern of postoperative middle thoracic esophageal squamous cell carcinoma(ESCC) and provide the evidence for designing the radiation target in postoperative radiotherapy. Methods From May 2007 to December 2015, a total of 752 patients with local recurrence of postoperative middle thoracic ESCC were included in this retrospective analysis. χ2 test was used to analyze the recurrent pattern of mediastinum, anastomotic, abdominal cavity and primary tumor bed. Results The median interval between surgery and recurrence was 14.6 months (1-106 months). The highest risk of recurrent site was mediastinum (79.7%), followed by supraclavicular and anastomotic(29.1% and 7.4%, respectively), but rarely occurred at the abdominal cavity and primary tumor bed(4.1% and 0.7%, respectively). The relapse rate differed significantly among the five sites (χ2=925.8, P<0.05). Furthermore, the relative metastatic rate in upper mediastinum was 74.2%, 19.8% in middle mediastinum and 4.8%in the lower.There was statistically significant difference in the relative metastatic rate among the three sites(χ2=791.6, P<0.05). Recurrences occurred highly at the 7th, 1st-5th regions, but rarely at 6th, 8th-10th regions. There was significant difference among these 10 regions from the mediastinum(χ2=486.9, P<0.05). The lymphatic metastasis of superior mediastinum was mainly distributed at paratracheal lymph nodes. The metastatic rate of right paratracheal lymph nodes was 47.1% including 1R,2R and 4R regions and the left paratracheal lymph nodes was 29.4% including 1L, 2L and 4L regions. The metastatic rate of right supraclavicular paratracheal lymph nodes was significantly higher than that of left ones(χ2=31.5, P<0.05). Conclusions Local recurrence mainly occurred in the bilateral supraclavicular areas, upper/middle mediastinum and anastomosis in patients with middle thoracic ESCC. The bilateral supraclavicular areas, 1st-5th regions of superior mediastinum, 7th region of middle mediastinum and anastomosis should be included in the postoperative prophylactic irradiation target volume. |
| HTML 查看全文 查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|