食管癌术后复发转移的预后及影响因素探讨  

Clinical significance of esophageal cancer following tumor resection

作　　者：陈建华[1] 卫功铨[2] 高宗人[2] 桑玫[2] 

机构地区：[1]东莞市人民医院肿瘤外科,广东省东莞523018 [2]河南省肿瘤医院胸外科

出　　处：《中国基层医药》2006年第2期229-231,共3页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨食管癌术后复发转移的预后及其影响因素和治疗效果。方法回顾性分析食管胸段鳞癌根治术后复发转移患者312例临床资料。结果术后复发转移时间为2～56个月，平均17．8个月。复发转移类型：淋巴性转移188例，血行性转移42例，混合型转移60例，吻合口复发22例。全组半年及1、2、3年生存率依次为未治疗组（68例）63．5％、35．2％、16．3％、13．1％；单纯放疗组（110例）75．6％、49．2％、32．7％、14．8％；单纯化疗组（72例）65．7％、52．3％、11．9％、9．2％；放疗＋化疗组（32例）为90．1％、72．5％、26．7％、17．2％。与未治疗组比较，单纯放疗（P=0．02）和放疗＋化疗（P=0．01）的生存率较高．单纯化疗差异无显著意义（P=0．185）。多因素分析显示：肿瘤浸润深度、淋巴结转移、手术方式及不同治疗方案是影响生存率的预后因素。结论食管癌手术方式的选择以颈部吻合术为宜，颈清扫术仅限于少数患者。放疗和（或）化疗可提高食管癌术后复发转移的生存率。Objective To determine the treatment outcome and prognosis after resection of esophageal cancer. Methods 312 patients who developed recurrence after curative resection for squamous cell cancer of the thoracic esophagus were analyzed retrospectively. Results Recurrence was found after a mean period of 17.8 months（range 2-56 months）. Recurrence pattern was catagorized into lymphatic, hematogerous, mixed and anastomotic. The number of patients in each recurrence group was 188,42,60,22. 312 patients were enveloped into a noadjuant treatment group（NT,68）, a radiotherapy alone group（RT, 110）, a chemotherapt group（CT, 72 ） and a radiotherapy combined chemothepapy（CRT ＋ CT,32）. The 0.5-, 1-,2- and 3- year overall survival rates for NT were 63.5 %, 35. 2%,16.3% and 13.1% ;For CT were 65. 796,52.3% ,11.9% and 9.2% ;For RT were 75,6% ,49.2% ,32.2% and 14.2 %, respectively. Compared with CT there were significant differences in survival for patients receiving RT alone or combined with CT（ P 〈 0.05 ）. Whereas, there were no significant difference for CT（ P 〉 0.05 ）. Multivariate analysis showed that depth of tumor invasion,lymph node metastasis,operative procedure and different regimens of therapy were significant prognostic factors. Conclusion Esophagectomy with cervical anastomasis is recommened for esophageal carcinoma,additional cervical lymphadenectomy is benefical in a few patients. Radiotherapy or combined with chemotherapy to be effective in prolonging the survival of patiems with recurrenes after esophageal resection for cancer. Investigation for more effective drugs and regimens of chemotherapy need to be taken.

关 键 词：食管肿瘤 肿瘤转移 复发 预后 影响因素 

分 类 号：R735.1[医药卫生—肿瘤]