【摘要】 目的 探讨食管鳞状细胞癌(鳞癌)根治性切除术辅助性化疗对患者生存率的影响。方法 收集1987～1992年间行肿瘤根治性切除术的97例原发性食管鳞癌患者的临床病理及随访资料,进行回顾性队列研究,分析食管鳞癌患者临床病理学特征和术后辅助化疗与术后生存期的关系。统计学方法包括Kaplan-Meier法、Log-rank时序检验和Cox多元回归模型进行统计分析。结果 97例患者中单纯手术组与术后辅助化疗组的临床病理学特征差异无统计学意义;影响食管鳞癌患者术后生存时间的主要因素有:肿瘤大小、分化程度、浸润深度、生长方式、间质炎性反应、有无淋巴结转移、nm23表达、EGFR表达及术后化疗;早期患者中,单纯手术组术后生存率高于术后辅助化疗组,而相对晚期患者术后生存时间两组差异未见显著性。结论 食管鳞癌患者手术后的治疗方案应根据肿瘤的生物学特征和临床分期慎重选择,尤其应重视早期患者治疗方案及其疗效的研究。更多还原

【Abstract】 Objective To study the prognostic factors affecting the survival rate after extendedradical esophagectomy with three-field lymph node dissection for squamous cell carcinoma and the effect ofpostoperative chemotherapy. Methods Out of 126 patients with original squamous cell carcinoma ofesophagus who accepted extended radical esophagectomy with three-field lymph node dissection from 1987-1992 in a hospital,97 of them were included in this study. Data on the clinical/pathological characters andpost surgery survival records of the subjects’ were collected. Survival analysis methods included Kaplan-Meier, Log-rank test and Cox multivariable model and the effects of postoperative chemotherapy wereanalyzed for patients in early and late stages. Results There was no significant difference in clinical andpathological character between those patients only undergone surgery and patients accepting postoperativechemotherapy. The size of tumor, grade of differentiation of the tumor cells, infiltration deepness, with orwithout lymph node metastasis, expression of nm23 and EGFR and treatment after surgery etc. werecorrelated with the survival rate. For patients in early tumor stage, postoperative chemotherapy withcisplatin and 5-FU after surgery seemed to be a risk factor. For patients in late stage, postoperativechemotherapy with cisplatin and 5-FU after surgery did not seem to improve survival rate. Conclusion Itis imperative to study on the effect of adjuvant postoperative chemotherapy to patients, especially those atearly stage with squamous cell carcinoma of esophagus. Doctors must be scrupulous when making decisions.更多还原