【作者】 陈洁；

【导师】 顾文栋；

【作者基本信息】 苏州大学 ， 肿瘤学（专业学位）， 2020， 硕士

【摘要】 第一部分:放疗/放化疗对食管鳞癌根治术后淋巴结复发转移的疗效分析目的:食管癌根治术后发生区域淋巴结复发转移患者的生存预后较差,目前尚缺乏标准的治疗策略,其预后因素也存在争议。本研究旨在评估放疗±化疗作为挽救性治疗的临床疗效和预后因素。方法:研究回顾性分析83例食管鳞癌根治术后区域淋巴结复发患者的生存资料,评估放疗±化疗的疗效及相关预后因素。所有患者均接受放射治疗,其中74例接受了容积旋转调强放疗,9例接受了三维适形放疗,采用常规分割方案,剂量分布为50.4-66.2Gy,中位剂量60Gy。同步化疗方案主要为氟尿嘧啶类或铂类单药化疗,仅4例患者接受了铂类联合5-氟尿嘧啶/紫杉醇化疗方案。结果:中位随访时间为24个月(范围9-75个月)。术后1年,3年,5年的总生存(OS)率分别为83.0,40.1和35.1%。单纯放疗组(RT)患者的3年生存率为47.5%,同步放化疗组(CCRT)患者的3年生存率为41.9%。两组患者的总生存率无显著差异(p=0.570),而两组的肿瘤缓解率(CR+PR)分别为73.2和91.4%。Cox多因素分析显示,年龄与预后显著相关(年轻患者预后更差,p=0.034)。常见的毒性反应为食管炎、白细胞减少和贫血,其中18%的患者出现3级毒性反应,未发现治疗相关性死亡。结论:放疗/放化疗作为食管鳞癌根治术后淋巴结复发转移的挽救性治疗是有效可行的。第二部分:根治性放化疗/放疗与手术+淋巴结不全清扫+术后放疗对淋巴结阳性食管鳞癌的疗效比较目的:食管癌根治性切除术常因淋巴结清扫不彻底而导致疗效欠佳。本研究旨在探讨,对于淋巴结阳性食管癌患者,根治性放化疗/放疗(CRT/RT)是否比食管癌切除术+淋巴结不全清扫+术后放疗的疗效更好。方法:从2012年1月至2018年12月研究共纳入219例淋巴结阳性的食管鳞癌患者。其中,122例患者接受了根治性CRT/RT治疗,97例接受食管癌切除术+淋巴结不全清扫+术后放疗(淋巴结不全清扫联合术后放疗组)。研究比较根治性CRT/RT组和淋巴结不全清扫联合术后放疗组患者的生存差异,并运用倾向匹配分析减少两组之间的混杂因素。结果:在根治性CRT/RT组,放疗中位剂量60Gy(50.4-66.0Gy),同步化疗方案以5-氟尿嘧啶、铂类、紫杉醇为主。在淋巴结不全清扫联合术后放疗组,所有患者均完成术后放疗。倾向评分匹配后,根治性CRT/RT组和淋巴结不全清扫联合术后放疗组的5年OS率分别为47.6和18.9%(p=0.039)。Cox多因素分析显示,肿瘤分期较晚和淋巴结不全清扫术是不良预后因素。结论:对于淋巴结阳性食管癌患者,根治性放化疗/放疗可提供良好的生存预后;与手术后淋巴结残留相比,放化疗/放疗可能是更好的选择。更多还原

【Abstract】 Part I:Efficacy analysis of radiotherapy with or without chemotherapy on lymph node recurrence after radical resection of esophageal squamous cell carcinomaIntroduction:Patients with regional lymph node recurrence after radical resection of esophageal cancer have poor therapeutic outcomes.Currently,there is no standard treatment for regional lymph node recurrence,and its prognostic risk factors are not well-understood.The aim was to evaluate the clinical efficacy and prognostic factors of salvage radiotherapy with or without chemotherapy in these patients.Methods:The survival and prognostic factors of 83 patients with esophageal squamous cell carcinoma with regional lymph node recurrence after radical surgery were retrospectively analyzed.All patients underwent radiotherapy,of which 74 patients received volumetric modulated arc therapy,9 patients received three-dimensional conformal radiation therapy,administered using a conventional segmentation protocol with a dose distribution range of 50.4-66.2Gy(median dose of 60Gy).The concurrent chemotherapy regimen was mainly composed of either platinum or fluorouracil monotherapy,except for 4 patients who were given platinum plus 5-fluorouracil or paclitaxel.Results:The median follow-up time was 24(range,9-75)months.The overall survival(OS)rates at 1 year,3 years,and 5 years were 83.0,40.1,and 35.1%,respectively.The 3-year survival rate was 47.5%in patients with radiation alone and 41.9%in patients receiving concurrent chemoradiotherapy.There was no significant difference in overall survival rate between the two groups(p=0.570),while the response rate(CR+PR)in those two groups was 73.2 and 91.4%,respectively.By multivariate analysis of OS,age(worse in younger patients,p=0.034)was found to be significantly associated with disease prognosis.The commonly toxicities were esophagitis,leukopenia and anemia.18%patients experienced grade 3 toxicity and no treatment-related death occurred.Conclusions:These results of this retrospective analysis suggest that radiotherapy with or without chemotherapy is an effective and feasible salvage treatment for lymph node recurrence after radical resection of esophageal squamous cell carcinoma.Part II:Definitive Radiotherapy with or without Chemotherapy Versus Surgery with Incomplete Lymph Node Dissection Followed by Postoperative Adjuvant Therapy for Resected Node-Positive Esophageal Squamous Cell CarcinomaIntroduction:Radical resection of esophageal cancer results in poor therapeutic outcomes when residual lymph nodes occurred.This retrospective study aimed to determine whether definitive radiotherapy with or without chemotherapy(CRT/RT)improve overall survival(OS)compared with surgery(radical esophagectomy with incomplete lymph node dissection)followed by adjuvant therapy among such patients with node-positive esophageal squamous cell carcinoma.Methods:We selected a total of 219 patients with node-positive esophageal cancer,between January 2012 and December 2018.Of these,122 patients received definitive CRT/RT,while 97 were subjected to radical esophagectomy,with incomplete lymph node dissection followed by adjuvant radiotherapy(defined as incomplete lymph node dissection with postoperative radiotherapy group).Overall survival rates were compared among patients treated with definitive CRT/RT and those who underwent incomplete lymph node dissection,and propensity-matched analysis further performed to reduce confounding factors associated with the 2 procedures.Results:For patients treated with definitive CRT/RT,all completed radiotherapy with the median dose of 60Gy(range,50.4 to 66.0Gy).The concurrent chemotherapy regimen was mainly composed of fluorouracil,platinum or paclitaxel.For patients treated with incomplete lymph node dissection,all received postoperative radiotherapy.After propensity score matching,we recorded a 5-year overall survival rate of 47.6 and 18.9%(p=0.039)in the definitive CRT/RT and incomplete lymph node dissection with postoperative radiotherapy groups,respectively.Cox regression analysis,for prognosis,revealed that higher clinical stage and surgery with incomplete lymph node dissection yielded a high relative risk value.Conclusions:The findings herein indicate that definitive CRT/RT provides better survival rates than surgery with incomplete lymph node dissection for patients with node-positive ESCC,when residual lymph nodes are subjected to salvage treatments.更多还原