ⅡB~Ⅲ期食管癌根治术后预防性放疗疗效分析

宋春洋; 李腾; 赵彦; 许金蕊; 李曙光; 祝淑钗

doi:10.3971/j.issn.1000-8578.2018.17.1207

ⅡB~Ⅲ期食管癌根治术后预防性放疗疗效分析

Prognosis of Stage ⅡB-Ⅲ Thoracic Esophageal Carcinoma Patients Treated with Prophylactic After Radical Esophagectomy

摘要

摘要:
目的探讨术后预防性放疗对ⅡB、Ⅲ期胸段食管癌根治术患者生存的影响。
方法收集2007—2010年本院行食管胸段鳞癌根治术患者336例，其中ⅡB期65例、Ⅲ期271例；术后未行放疗组（S）220例，术后放疗组（S+R）116例；放疗中位剂量50 Gy。采用Kaplan-Meier法计算生存率及局控率；Log rank法检验行单因素预后分析。
结果随访率为98.2%，全组患者5年生存率及5年无进展生存率分别为29.3%和25.6%；中位生存时间及中位无进展生存时间分别为26.7月和17.4月。ⅡB期患者S组与S+R组5年生存率分别为30.1%与48.6%，差异无统计学意义（χ²=2.279, P=0.131）；Ⅲ期患者S组与S+R组5年生存率分别为24.9%与32.8%，差异有统计学意义（χ²=5.865, P=0.015）；术后病理淋巴结阳性患者S组与S+R组5年生存率分别为25.9%与35.8%，差异有统计学意义（χ²=7.663, P=0.006）；全组患者S组与S+R组的中位局控时间分别为10.6和16.3月，差异有统计学意义（χ²=6.043, P=0.014）。
结论食管癌根治术后预防性放疗可明显降低局部复发并使Ⅲ期及术后病理淋巴结阳性的患者生存获益。

Abstract:
Objective To investigate the effect of prophylactic radiotherapy after radical surgery on the long-term survival of patients with stage ⅡB-Ⅲ thoracic esophageal carcinoma.
Methods We enrolled 336 stage ⅡB (n=65) and Ⅲ(n=271) thoracic esophageal carcinoma patients who underwent radical resection with (S+R, n=116) or without (S, n=220) postoperative prophylactic radiotherapy from 2007 to 2010. The median dose of postoperative radiotherapy was 50 Gy. The Kaplan-Meier method, Log rank test and Cox model were used for survival rate calculation, univariate analysis and multivariate analysis, respectively.
Results The 5-year overall survival (OS) and disease-free survival rates were 29.3% and 25.6%, respectively. The 5-year OS of stage ⅡB patients in S and S+R groups were 30.1% and 48.6%, respectively (χ²=2.279, P=0.131). The 5-year OS of stage Ⅲ patients in S and S+R groups were 24.9% and 32.8%, respectively (χ²=5.865, P=0.015). The 5-year OS of lymph node-positive patients in S and S+R groups were 25.9% and 35.8%, respectively (χ²=7.663, P=0.006). Postoperative prophylactic radiotherapy resulted in significantly decreased intrathoracic and supraclavicular recurrence, and obviously delayed median local recurrence time in S and S+R groups (10.6 vs. 16.3 months; χ²=6.043, P=0.014).
Conclusion Postoperative prophylactic radiotherapy reduces local recurrence and improves the survival of stage Ⅲ or lymph node-positive thoracic esophageal carcinoma patients.

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