淋巴靶向化疗在食管癌切除术中应用价值的前瞻性研究  

Application value of lymph node-targeted chemotherapy in resection of the esophageal carcinoma： a prospective study

作　　者：郑希[1] 黄玥 袁勇[1] 蔡杰[1] 胡杨[1] 赵雍凡[1] 陈龙奇[1] Zheng Xi;Huang Yue;Yuan Yong;Cai Jie;Hu Yang;Zhao Yongfan;Chen Longqi(Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China)

机构地区：[1]四川大学华西医院胸外科,成都610041 [2]四川大学华西临床医学院,成都610041

出　　处：《中华消化外科杂志》2018年第4期366-371,共6页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金（81500419）;四川省科技厅科技支撑计划项目（2016FZ0104）

摘　　要：目的：探讨淋巴靶向化疗在食管癌切除术中的应用价值。方法：采用前瞻性研究方法。选取2013年1—12月四川大学华西医院收治的117例行经左胸食管切除及区域淋巴结清扫术的食管中段或下段癌（未累及食管胃结合部）患者的临床资料。采用半随机对照方法，将患者分为4组：CPL组，行经左胸食管切除及区域淋巴结清扫术中采用纳米活性炭吸附紫杉醇行淋巴靶向化疗；CFL组，行经左胸食管切除及区域淋巴结清扫术中采用纳米活性炭吸附氟尿嘧啶行淋巴靶向化疗；FV组，行经左胸食管切除及区域淋巴结清扫术前采用氟尿嘧啶行静脉化疗；对照组，直接行经左胸食管切除及区域淋巴结清扫术。CPL组和CFL组：术前配制纳米活性炭-化疗药物混悬液，术中用1 mL注射器在胸段食管肿瘤下缘黏膜下注射相应混悬液。FV组：氟尿嘧啶用100 mL生理盐水配制后，在术前行静脉滴注，30 min输注完毕。食管癌组织切取后，取胃左动脉旁淋巴结送药物浓度检测。上述3组患者在食管胃吻合术开始时，采集外周静脉血约3 mL，进行血清药物浓度检测。对照组：同期行经左胸食管切除及区域淋巴结清扫术，无需采集血样、食管组织标本。观察指标：（1）化疗患者淋巴结和血清药物浓度比较。（2）随访和生存情况：4组患者的4年累积生存率比较。术后采用门诊和电话方式进行随访，了解患者生存情况。随访时间截至2017年12月。正态分布且方差齐的计量资料用x±s表示，多组间比较采用方差分析；偏态分布的计量资料以M（P25，P75）表示，多组间比较采用Cruskal-Wallis秩和检验，两组间采用Mann-Whitney U检验或Wilcoxon符号秩和检验。计数资料比较采用x2检验或Fisher确切概率法。等级资料比较采用Kruskal-Wallis检验。采用Kaplan-Meier法绘制患者术后生存曲线，Log-rank检验进行生存分析�Objective：To investigate the application value of lymph node-targeted chemotherapy in resection of esophageal carcinoma. Methods：The prospective study was conducted. The clinical data of 117 patients with middle and low esophageal carcinoma （without involving esophagogastric junction） who underwent left transthoracic esophagectomy and regional lymph node dissection in the West China Hospital of Sichuan University between January 2013 and December 2013 were collected. All patients were allocated into the 4 groups by semi-randomized control method： CPL group received intraoperatively carbon nanoparticles-paclitaxel for lymph node-targeted chemotherapy, CFL group received intraoperatively carbon nanoparticles-fluorouracil for lymph node-targeted chemotherapy, FV group received preoperative fluorouracil intravenous chemotherapy, and control group underwent left transthoracic esophagectomy and regional lymph node dissection. CPL and CFL groups： suspensions of carbon nanoparticles and chemotherapy drugs were preoperatively prepared, and were intraoperatively injected under mucosa of lower edge of thoracic esophageal tumor using 0.1 mL syringes. FV group： fluorouracil with 100 mL of saline were mixed, and then were preoperatively injected by intravenous drip within 30 minutes. After cutting tissues of esophageal carcinoma, lymph nodes of left gastric arteria were removed, and drug level in lymph nodes was measured. At the beginning of esophagogastrostomy in the CPL, CFL and FV groups, 3 mL peripheral venous blood were collected and measured for serum drug level. Control group： patients underwent left transthoractic esophagectomy and regional lymph node dissection （no blood sample and esophageal specimen）. Observation indicators： （1） comparison of drug levels in lymph node and serum of patients with chemotherapy; （2） follow-up and survival： 4-year cumulative survival rate in 4 groups. Follow-up using outpatient examination and telephone interview was performed to detect patients′ survi

关 键 词：食管肿瘤 外科手术 淋巴结转移 抗肿瘤药物 纳米活性炭 生存率 淋巴靶向化疗 转化医学 

分 类 号：R735.1[医药卫生—肿瘤]