Ⅲ期胸段食管鳞癌根治术后的复发规律  

Patterns of recurrence in patients with stage m thoracic esophageal squamous cell carcinoma after radical resection

作　　者：王玉祥[1,2] 杨琼[1,2] 何明[3] 邱嵘[1] 李静[1] 祝淑钗[1] 乔学英[1] 齐战[3] 

机构地区：[1]河北医科大学第四医院放疗科,石家庄050011 [2]河北省邯郸中心医院放疗科,056001 [3]河北医科大学第四医院胸外科

出　　处：《中华肿瘤杂志》2017年第1期48-55,共8页Chinese Journal of Oncology

基　　金：河北省医学科学研究重点课题（20150759）

摘　　要：目的探讨Ⅲ期胸段食管鳞癌根治术后的复发规律及其对术后放疗靶区设计的指导价值。方法收集Ⅲ期胸段食管鳞癌根治术后患者395例，其中男302例，女93例。行胸腹两野手术375例，行三野手术20例；单纯手术、术后化疗、放疗和放化疗患者分别为97、212、56和30例。术后复发主要依据CT扫描结果。结果全组患者的总失败率为75．7％，其中局部区域复发、远处转移和局部区域复发合并远处转移患者分别占48．4％、6．2％和4．3％。发生局部区域复发208例（52．7％），其中颈部和（或）锁骨上区复发占26．9％（56／208，其中51例为锁骨上区复发），纵隔占69．7％（145／208），上腹部占19．7％（41／208，其中38例为腹主动脉旁淋巴结复发）。Logistic多因素回归分析显示，TNM分期和术后辅助治疗为影响患者局部区域复发的独立危险因素（均P〈0．05）。术后放疗能降低局部区域复发。术后化疗则不能降低局部区域复发。结论Ⅲ期胸段食管鳞癌术后失败主要为局部区域复发，临床分期越晚局部区域复发率越高，术后放疗能降低局部区域复发。上纵隔复发最常见。其次为锁骨上和腹主动脉旁区，这些区域可能是术后放疗的主要靶区。Objective To evaluate the patterns of recurrence and their value on target delineation for postoperative radiotherapy （RT） in patients with stage m thoracic esophageal squamous cell carcinoma （ESCC） after esophagectomy. Methods 395 patients （ 302 male and 93 female） of stage Ⅲ thoracic ESCC after radical resection were enrolled in this study. Among them, 375 patients were treated with two-field and other 20 with three-field esopahgectomy. 97 patients were treated with surgery alone, 212 with adjuvant postoperative chemotherapy （CT）, 56 with radiotherapy （RT） and 30 with CT plus RT. Diagnosis of recurrence was primarily based on CT images, some of which were biopsy confirmed. The location and patterns of tumor recurrence were analyzed. Results The overall failure rates was 75.7% （299/395）. Locoregional recurrence （LR） was found in 48.4% of the patients, distant metastasis （DM） in 16.2%, and LR plus DM in 4.3%. There were 208 patients occurred with LR, 26.9% （56） recurred in supraclavieular/ neck （51 in supraclavieular） , 69.7% （145） in mediastinum （88.7% in upper-mediastinum） , and 19.7% （41） in upper abdomen （38 in para-aortic lymph node）. Chi-square test and logistic multivariate regression analysis showed that TNM stage and adjuvant therapy were significantly associated with LR （P〈 0.05 ）. Postoperative RT reduced LR （mainly LR in mediastinum） , but postoperative CT did not decrease LR. Conclusions The recurrence rate is very high in stage m thoracic ESCC patients, LR is the main pattern of failure. TNM stage is one of the most important factors for LR. Postoperative radiotherapy can reduce LR but postoperative chemotherapy does not decrease LR. Upper-mediastinum is the most common site of recurrence, followed by supraclavicular and para-aortie regions; these areas should be considered as the key target of postoperative radiotherapy.

关 键 词：食管肿瘤 食管切除术 复发 放射疗法 计算机辅助 抗肿瘤联合化疗方案 

分 类 号：R735.1[医药卫生—肿瘤]