胸中段食管癌561例术后局部复发规律和放射治疗靶区设计  

Local recurrence regular pattern of postoperative middle thoracic esophageal carcinoma and design of radiotherapy target volume in 561 cases

作　　者：张耀文[1] 郑安平[1] 董尚文[2] 秦蔚然 

机构地区：[1]安阳市肿瘤医院放疗一科,河南安阳455000 [2]天津医科大学总医院心胸外科,天津300052

出　　处：《新乡医学院学报》2015年第6期519-521,525,共4页Journal of Xinxiang Medical University

基　　金：国家自然科学基金青年科学基金项目(编号:81201945);天津医科大学科学基金(编号:2011KY08)

摘　　要：目的探讨胸中段食管癌术后局部复发的规律,为术后放射治疗的靶区设计提供依据。方法回顾性分析安阳市肿瘤医院2009年1月至2014年6月收治的561例胸中段食管癌术后局部复发患者的临床资料,采用χ^2检验分析各复发区域情况。结果术后局部复发时间为1-104个月,中位时间14个月。术后复发率最高的区域为纵隔77.7%（436/561）,其次为锁骨上29.2%（164/561）,吻合口7.7%（43/561）,腹腔3.9%（22/561）和原瘤床0.5%（3/561）,5个区域的复发率比较差异有统计学意义（P=0.000）。上纵隔淋巴结转移率达73.1%（410/561）,中纵隔为19.6%（110/561）,下纵隔为4.4%（25/561）,三者间比较差异有统计学意义（P=0.000）。纵隔转移淋巴结分区中1R区为33.9%（190/561）,2R区为20.5%（115/561）,4R区为7.6%（43/561）,1L区为12.8%（72/561）,2L区为10.3%（58/561）,4L区为10.2%（57/561）,3区（3A＋3P）为14.3%（80/561）,7区为23.0%（129/561）;以1R区较多,6区、8-10区较少,差异有统计学意义（P=0.000）;上纵隔淋巴结转移主要分布于气管旁,其中左气管旁区（1L、2L、4L）淋巴结转移率为30.3%（170/561）,右气管旁区（1R、2R、4R）淋巴结转移率为45.8%（257/561）,右气管旁淋巴结转移率高于左气管旁区（P=0.000）。结论胸中段食管癌术后复发位置主要在双侧锁骨上、中上纵隔、吻合口,建议术后预防放射治疗靶区采用以双侧锁骨上区、上纵隔1-5区、中纵隔7区及吻合口为主的T型野。Objective To study the local recurrence regular pattern of postoperative middle thoracic esophageal carcinoma（ ECSC） and provide the evidence for designing the radiation field in postoperative radiotherapy. Methods The data of561 patients with local recurrence of postoperative middle thoracic ECSC in Anyang Tumor Hospital from January 2009 to June2014 was analyzed retrospectively. A χ^2test was used to analyze the recurrence pattern. Results The interval between surgery and recurrence was 1- 104 months,with a median interval of 14 months. The most frequent site of recurrence was mediastinum（77. 7%）,followed by supraclavicular and anastomotic（29. 2%,7. 7%）,and recurrence occurred rarely at the abdominal cavity and primary tumor bed（3. 9% and 0. 5%,respectively）;there was significant difference in recurrence rate among the five sites（ P = 0. 000）. Furthermore,the relative metastasis rate in upper mediastinum was 73. 1%（410 /561）,in middle mediastinum was 19. 6%（110 /561） and in the lower mediastinum was 4. 4%（25 /561）. There was significant difference in the relative metastasis rate among the three sites（ P = 0. 000）. In mediastinum the rate of 1R region was 33. 9%（190 /561）,2R region was 20. 5%（115 /561）,4R region was 7. 6%（43 /561）,1L region was 12. 8%（72 /561）,2L region was 10. 3%（ 58 /561）,4L region was 10. 2%（57 /561）,3 area（3A ＋ 3P） was 14. 3%（80 /561） and 7 area was 23. 0%（129 /561）;the most recurrence site was 1R and recurrence occurred rarely at 6,8- 10 regions;there was significant difference（ P = 0. 000）. The lymphatic metastasis of superior mediastinum mainly distributed to paratracheal lymph nodes;the metastasis rate of left paratracheal lymph nodes was 30. 3%（ 170 /561） including 1L,2L and 4L regions; the metastasis rate of right paratracheal lymph nodes was 45. 8%（257 /561） including 1R,2R and 4R regions. The metastasis rate of right supraclavicular paratracheal lymph nodes was significantly higher than that of lef

关 键 词：食管肿瘤 淋巴转移 放射疗法 靶区 

分 类 号：R735.1[医药卫生—肿瘤]