【摘要】 目的探讨影响N0期食管鳞癌根治术后的预后因素,并评价术后预防性放疗价值。方法分析1993年1月~2006年11月本院食管癌根治术后病理诊断证实均为鳞癌,无淋巴结转移及远处转移N0期患者859例,其中单纯手术760例,术后放疗99例。术后3~4周开始放疗,照射中位总剂量50 Gy,分25次,2 Gy/次,5次/周,5周完成。结果全组1、3、5、10年生存率分别为93.4%、81.5%、72.9%和65.5%,影响预后的单因素分析是性别、年龄、病变长度和pT分期,多因素分析显示年龄和pT分期是影响预后的独立因素。术后放疗较单纯手术可提高pT4期和病变长度>5 cm的生存率,5年生存率分别为67.1%、34.6%和81.3%、70.2%,差异有统计学意义(P<0.05),并能降低pT4期瘤床复发率;而对病变长度≤5 cm、不同病变部位、食管残端癌、脉管癌栓和pT1-3期患者术后放疗的生存率没有提高,差异均无统计学意义(P>0.05)。结论年龄和肿瘤侵润深度是影响N0期食管鳞癌根治术后预后的重要因素,术后预防性放疗可明显提高pT4期及病变长度>5 cm的生存率和降低pT4期瘤床复发率。更多还原

【Abstract】 Objective To evaluate the value of postoperative radiotherapy after surgery for N0 esophageal carcinoma,and to analyze its prognostic factors.Methods From Jan 1993 to Nov 2006,859 patients with esophageal squamous cell carcinoma were enrolled into this study.All patients were diagnosed as stage N0 tumors pathologically after surgery in our hospital.Among them,760 patients received surgery alone,99 patients received surgery followed by postoperative adjuvant radiotherapy.Radiotherapy started within 3～4 weeks after surgery.The median total dose was 50 Gy(2 Gy/fraction,25 fractions,completed in 5 weeks).Univariate analysis and COX regression analysis were used to analyze the possible prognostic factors.Results The 1-,3-,5-and 10-year overall survival rates were 93.4%,81.5%,72.9% and 65.5% respectively.Univariate analysis showed prognostic factors after surgery were sex,age,vessel invasion,primary carcinoma length and pT stage.COX regression analysis showed that age and pT stage were independent factors for prognosis.The 5-year overall survival rates were 72.2% vs.77.4% in surgery alone group vs.postoperative radiotherapy group(χ2=0.13,P>0.05).For pT4 and tumor length>5 cm patients,the 5-year overall survival rates were 34.6% and 70.2% for surgery alone group vs.67.1% and 81.3% for postoperative radiotherapy group(χ2=7.72,P<0.05;χ2=4.01,P<0.05).Postoperative radiotherapy could decrease recurrence rate for pT4 patients.Conclusion Age and tumor invasive depth are independent prognostic factors for N0 patients.Postoperative radiotherapy for N0 esophageal carcinoma can significantly improve survival of pT4 N0 patients.更多还原