术后辅助3DRT改善pT3N0M0期食管癌患者长期生存  

Postoperative adjuvant three-dimensional conformal radiotherapy improves long-term survival in patients with pathological T2-3N0M0 esophageal cancer

作　　者：杨劲松[1] 章文成[1,2] 肖泽芬[1] 周宗玫[1] 张红星[1] 陈东福[1] 冯勤付[1] 赫捷[3] 高树庚[3] 孙克林[3] 刘向阳[3] 方德康[3] 牟巨伟[3] 王大力[3] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院放疗科,100021 [2]天津肿瘤医院放疗科,300000 [3]北京协和医学院中国医学科学院肿瘤医院胸外科,100021

出　　处：《中华放射肿瘤学杂志》2015年第2期101-105,共5页Chinese Journal of Radiation Oncology

基　　金：首都临床特色应用研究（Z121107001012004）;北京希望马拉松专项基金（LC2012201）;国家自然科学基金（81272512）;北京协和医学院博士生创新基金（2013-1002-21）

摘　　要：目的 评价3DRT （3DCRT、IMRT）在pT3N0M0期胸段食管鳞癌根治术后辅助治疗中的临床价值.方法 分析2004-2011年本院入组pT3N0M0期胸段食管鳞癌根治术后3DRT前瞻性非随机Ⅱ期临床研究的96例及同期全部单纯手术820例患者的复发、生存及放疗不良反应.Kaplan-Meier法计算生存率并Logrank检验,Cox模型预后多因素分析.结果 术后放疗组T3期、肿瘤长度≥5 cm患者比例显著高于单纯手术组.术后放疗、单纯手术组5年样本数分别为35、270例.术后放疗、单纯手术组5年OS率分别为74.3％、59.9％ （P =0.010）,5年DFS率分别为71.0％、51.7％（P=0.002）.多因素分析显示术后放疗是影响OS、DFS的因素（P=0.030、0.004）.术后放疗组和单纯手术组总复发率、LRR率、远处转移率分别为22.9％和43.0％（P=0.000）、18.8％和35.2％（P=0.001）、11.5％和21.3％ （P=0.024）.术后放疗组25例（26.0％）发生3级早晚期不良反应.结论 辅助3DRT较单纯手术降低了pT3 N0 M0期胸段食管鳞癌术后复发率,提高了5年DFS、OS.鉴于pT2N0M0q期与pT3N0M0期患者复发相似,建议辅助放疗.以上仍需前瞻性Ⅲ期随机研究证实.Objective To assess the clinical value of three-dimensional conformal radiotherapy （3DRT） in postoperative adjuvant therapy after initial radical surgery for pathological T2-3 N0M0 thoracic esophageal squamous cell carcinoma （pT3N0M0 TESCC）.Methods The recurrence,survival,and radiotherapy adverse events in 96 patients with pT3 N0M0 TESCC who received adjuvant 3DRT after radical surgery from a prospective nonrandomized phase Ⅱ clinical study from 2004 to 2011 were compared with those in 820 patients undergoing surgery alone.The survival rate was determined by the Kaplan-Meier method and analyzed using the log-rank test.Multivariate prognostic analysis was performed using the Cox proportional hazard model.Results Postoperative 3DRT group had a significantly higher ratio of patients with tumor length ≥ 5 cm and stage T3 than surgery alone group.The 5-year sample sizes for the postoperative 3DRT and surgery alone groups were 35 and 270,respectively.The 5-year overall survival （OS） and disease-free survival （DFS） rates for the postoperative 3DRT versus surgery alone group were 74.3% vs.59.9% （P =0.010） and 71.0% vs.51.7% （P =0.002）,respectively.Multivariate analysis revealed that 3 DRT was independently associated with an improved OS （P =0.030） and DFS （P =0.004）.The overall recurrence rate,locoregional recurrence rate,and distant metastasis rate in the postoperative 3DRT group versus surgery alone group were 22.9% vs.43.0% （P=0.000）,18.8% vs.35.2% （P=0.001）,and 11.5% vs.21.3% （P=0.024）,respectively.Both early and late grade 3 adverse events developed in 25 patients （26.0%） in the postoperative 3DRT group.Conclusions Compared with surgery alone,adjuvant 3DRT reduces the recurrence rate and improves the 5-year DFS and OS in patients with pT3 N0 M0 TESCC.Adjuvant 3DRT is recommended for pT2N0M0 patients inview of the similar recurrence to that of pT3 N0 M0 patients.Prospective randomized phase Ⅲ clinical study is still needed.

关 键 词：食管肿瘤/外科学 食管肿瘤/放射疗法 放射疗法 调强 放射疗法 三维适形 放射疗法 术后 预后 

分 类 号：R735.1[医药卫生—肿瘤]