胸段食管鳞癌伴或不伴颈部淋巴结转移同期放化疗预后分析  

Prognosis Analysis of Thoracic Esophageal Squamous Cell Carcinoma with/without Cervical Lymph Node Metastasis Treated with Concurrent chemotherapy

作　　者：张鹏[1] 习勉[1] 李巧巧[1] 何立儒[1] 赵磊[1] 刘施亮 沈静娴[1] 刘孟忠[1] 

机构地区：[1]华南肿瘤学国家重点实验室∥中山大学肿瘤防治中心放射治疗科,广东广州510060

出　　处：《中山大学学报（医学科学版）》2014年第3期412-417,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省科技计划项目(2012B031800287)

摘　　要：【目的】探讨颈部淋巴结的转移侧数对非手术胸段食管鳞癌预后的影响及胸段食管鳞癌放化疗预后因素。【方法】将395例接受同期放化疗治疗的食管鳞癌患者分为五组:A组,无区域淋巴结转移及远处转移;B组,伴有区域淋巴结转移;C组,单侧颈部淋巴结转移不伴有其他远处转移;D组,双侧颈部淋巴结转移不伴有其他远处转移;E组,其他远处转移。研究终点是总生存率及无进展生存率,并对预后因素进行单因素和多因素分析。【结果】A、B、C、D、E组的3年OS分别为47.6%、46.4%、33.5%、14.8%、5.7%(P=0.000);3年无进展生存率分别为45.2%、39.5%、26.4%、4.9%、4.3%(P=0.000)。单因素分析显示性别、肿瘤长度、T分期、M分期、化疗方案及疾病分组对总生存率及无进展生存率有影响。多因素分析显示T分期、化疗方案及疾病分组为总生存率和无进展生存率的独立预后因素。【结论】对于胸上段和胸中段食管癌,与双侧颈部淋巴结转移相比,胸段食管鳞癌伴单侧颈部淋巴结转移预后更好,可考虑视为区域性病变。性别、T分期、同期化疗方案及颈部淋巴结转移侧数是胸段食管鳞癌的独立预后因素。[Objective] To assume that the laterality of cervical lymph nodal metastases （CLNM） has an influence on prognosis for inoperable thoracic esophageal squamous cell carcinoma.[Methods] A total of 395 inoperable esophageal SCC patients receiving chemoradiotherapy were classified into five groups according to different disease stadium of metastasis：Group A,no evidence of regional lymph nodal disease ; Group B,evidence of regional lymph nodal disease; Group C,evidence of unilateral cervical lymph node metastases （CLNM）; Group D,evidence of bilateral CLNM; Group E,evidence of other metastatic diseases.The endpoints were overall survival （OS）,progression-free survival （PFS）.The prognostic factors were examined in the univariate and multivariate analysis.[Results] Three year OS of Group A,B,C,D,E were 47.6％,46.4％,33.5％; 14.8％,5.7％ （P=0.000）.On univariate analysis,sex,tumor location,length,T stage,M stage,chemotherapy regimen and disease stage were significantly associated with OS （P ＜ 0.05）.Multivariate analysis demonstrated that sex,T stage,chemotherapy regimen and disease stage were prognostic factors on OS.[Conclusion] Compared to bilateral CLNM,unilateral CLNM is associated with longer OS in esophageal SCC and should be regarded as regional disease,especially,in SCCs of the upper and middle thirds of the esophagus.Female sex,earlier T stage,cisplatin plus docetaxel as part of concurrent chemoradiotherapy and unilateral cervical nodal lymph metastasis are independent predictors of survival in esophageal SCC.

关 键 词：食管癌 颈部淋巴结转移 同期放化疗 预后因素 

分 类 号：R735.1[医药卫生—肿瘤]