新辅助同步放化疗与新辅助化疗治疗局部进展期食管鳞癌的疗效分析  

Effect analysis of neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy in the treatment of locally advanced esophageal squamous cell carcinoma

作　　者：郑浩[1] 汪灏[1] 唐汉[1] 林森[1] 方勇[1] 沈亚星[1] 谭黎杰[1] 

机构地区：[1]复旦大学附属中山医院胸外科,上海200032

出　　处：《中华消化外科杂志》2017年第5期464-468,共5页Chinese Journal of Digestive Surgery

基　　金：上海市科委医学引导项目（16411965900）

摘　　要：目的比较新辅助同步放化疗与新辅助化疗治疗局部进展期食管鳞癌的临床疗效。方法采用回顾性队列研究方法。收集2010年1月1日至2015年12月31日复旦大学附属中山医院收治的156例局部进展期食管鳞癌患者的临床病理资料。156例患者中，59例行新辅助同步放化疗设为新辅助放化疗组，97例行新辅助化疗设为新辅助化疗组。新辅助放化疗组采用紫杉醇＋NSn方案化疗2个周期＋放疔40Gy（2Gy／d）；新辅助化疗组采用紫杉醇＋顺铂方案化疗2个周期。两组患者新辅助治疗结束6周后再次行影像学检查评估，行胸腔镜右胸腹左颈三切口食管癌手术。观察指标：（1）治疗情况。（2）术后病理学检查情况。（3）随访和生存情况。采用门诊和电话方式进行随访，第1。2年每3个月随访1次，第3年开始每半年随访1次。随访内容为肿瘤标志物水平（CEA、鳞状细胞癌相关抗原），胸腹部cT检查，颈部及腹部超声检查，必要时行胃镜或PET／CT检查；了解患者生存情况。随访时间截至2017年1月。正态分布的计量资料以2-s表示，组间比较采用t检验；偏态分布的计量资料以肘（范围）表示，组间比较采用非参数检验。计数资料比较采用疋。检验或Fisher确切概率法。等级资料比较采用非参数检验。采用寿命表法计算生存率，Log—rank检验比较患者生存情况。结果（1）治疗情况：两组患者均能耐受新辅助治疗＋胸腔镜食管癌切除术。新辅助放化疗组和新辅助化疗组患者中分别有6例和15例中转开胸手术，手术时间分别为（201-25）rain、（195-20）min，术中出血量分别为（137±66）mL、（133-58）mL，术后再次人住1CU患者分别为5、8例，术后发生并发症患者分别为24例（肺部并发症10例、吻合口漏8例、声音嘶哑3例、心血管并发症2例、乳糜胸1例）和30例（吻合口漏11例、肺部并发症10例�Objective To compare the clinical effect of neoadjuvant ehemoradiotherapy （nCRT） and neoadjuvant chemotherapy （nCT） in the treatment of locally advanced esophageal squamous cell carcinoma. Methods The retrospective cohort study was conducted. The clinicopathological data of 156 patients with local advanced esophageal squamous cell carcinoma who were admitted to the Zhongshan Hospital of Fudan University from January 1, 2010 to December 31, 2015 were collected. Among 156 patients, 59 undergoing nCRT were allocated into the nCRT group and 97 undergoing nCT were allocated into the nCT group. Patients in the nCRT group and nCT group respectively received 2 cycles chemotherapy by the TP regimen＋40 Gy radiotherapy （2 Gy/d） and 2 cycles chemotherapy by the TP regimen. Patients were evaluated by imaging examinations after 6 weeks neoadjuvant therapy completion, and then underwent abdominal and right chest-left cervico three-incision thoracoscopic surgery. Observation indicators： （1） treatment situations; （2） postoperative pathological examination; （3） follow-up and survival situations. Follow-up using outpatient examination and telephone interview was performed once every 3 months within 2 years and once every 6 months after 3 years up to January 2017. Follow-up included levels of tumor markers [ carcinoembryonic antigen （CEA） and SCC-Ag ], thoracic or abdominal computed tomography （CT）, neck and abdominal ultrasonography and gastroscopy or PET/CT examination if necessary. Measurement data with normal distribution were represented as ：~ __.s and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were described as M （range） and comparison between groups was analyzed using the nonparametric test. Count data were analyzed using the chi-square test or Fisher exact probability. Comparison of ordinal data was done by the nonparametric test. The survival rate was calculated using the life table method and survival was analyzed by the Log-r

关 键 词：食管肿瘤 外科手术 新辅助放化疗 新辅助化疗 

分 类 号：R735.1[医药卫生—肿瘤]