术前新辅助化疗对食管鳞癌患者胸腹腔镜手术及预后的影响  

Effects of preoperative neoadjuvant chemotherapy on thoracoscopic and laparoscopic surgery and its impact on prognosis in patients with esophageal squamous cell carcinoma

作　　者：华胸怀[1] 魏秀峰 史可峰 于永魁 李印 陈先凯 刘奇 曲戈[1] 李浩淼[1] 钱如林 Hua Xionghua;Wei Xiufeng;Shi Kefeng;Yu Yongkui;Li Yin;Chen Xiankai;Liu Qi;Qu Ge;Li Haomiao;Qian Rulin.(Department of Thoracic Surgery,Henan Provincial Chest Hospital,Zhengzhou 450000,China;Department of Thoracic Surgery,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,China;Department of Thoracic Surgery,Cancer Hospital Chinese Academy of Medical Sciences,Beijing 100021,China)

机构地区：[1]河南省肿瘤医院胸外科,郑州450000 [2]新乡医学院第一附属医院胸外科,卫辉453100 [3]中国医学科学院肿瘤医院胸外科,北京100021

出　　处：《中华胸部外科电子杂志》2019年第2期91-96,共6页CHINESE JOURNAL OF THORACIC SURGERY：Electronic Edition

摘　　要：目的 探讨新辅助化疗对食管鳞癌患者胸腹腔镜手术及预后的影响。方法 收集2012年1月—2013年12月收治的168例食管鳞癌患者的资料,依据治疗方式分为新辅助化疗联合胸腹腔镜手术组(联合治疗组, n =80)和单纯胸腹腔镜手术组(单纯手术组,n =88)。联合治疗组术前给予多西紫杉醇联合顺铂方案的化疗(2个周期);单纯手术组为同期直接手术。手术方式均为胸腹腔镜食管癌根治术。比较两组术后并发症发生率、根治性切除率及淋巴结转移情况,采用Kaplan-Meier方法进行生存分析。结果 联合治疗组患者均完成2个周期的化疗,完全缓解19例(23.8%),部分缓解47例(58.8%),客观有效率为82.6%。术后并发症两组间差异无统计学意义( P >0.05);联合治疗组和单纯手术组的根治性切除率分别为93.8%和83.0%,淋巴结转移率分别为23.8%和43.3%,淋巴结转移度分别为6.7%和9.3%,组间比较差异均有统计学意义( P< 0.05)。第1、2、5年总生存率,联合治疗组分别为93.3%、72.8%和42.7%,单纯手术组分别为90.2%、68.9%和36.8%,两组间比较差异无统计学意义( P > 0.05);第1、2、5年无瘤生存率,联合治疗组为90.2%、62.7%和 38.8%,单纯手术组81.1%、54.1%和21.6%,两组间比较差异有统计学意义( P <0.01)。结论 食管鳞癌胸腹腔镜术前采用新辅助化疗可降低肿瘤临床分期,减少淋巴结转移风险,提高手术根治率,改善患者预后。Objective To explore the effects of preoperative neoadjuvant chemotherapy on thoracoscopic and laparoscopic surgery and the impact on prognosis in patients with esophageal squamous cell carcinoma. Methods This study retrospectively analyzed 168 patients with esophageal squamous cell carcinoma from January 2012 to December 2013. In these patients, 80 cases received neoadjuvant chemotherapy with docetaxel and cisplatin for two treatment cycles and thoracoscopic and laparoscopic surgery (CTLS) afterwards . The other 88 cases were treated with CTLS alone. Postoperative complication rates,radical resection rates, lymph-node metastasis and survival prognosis (by Kaplan-Meier Curve) were compared between the two groups. Results The patients with neoadjuvant chemotherapy can tolerate two-cycle chemotherapy. In the neoadjuvant chemotherapy group, the complete remission rate was 23.8%;the partial remission rate was 58.8%;therefore, the total effective rate was 82.6%. There was no significant difference in postoperative complications between the two groups( P >0.05). The radical resection rate in the group of preoperative neoadjuvant chemotherapy followed by CTLS was 93.8%, which was higher than 89.2% of CTLS alone. The difference between the two groups was statistically significant( P <0.05). The metastatic lymph node ratio in the two groups were respectively 23.8% and 43.3%( P <0.05).The degree of lymphatic metastasis in the two groups were respectively6.7% and 9.3%( P <0.05). The overall 5-year survival rate for the patients with preoperative neoadjuvant chemotherapy followed by CTLS and the patients with CTLS alone was 42.7% and 36.8% respectively( P >0.05).The 5-year tumor-free survival rate for the patients with preoperative neoadjuvant chemotherapy followed by CTLS and the patients with CTLS alone was 38.8% and 21.6%, respectively( P <0.01). Conclusions Preoperative neoadjuvant chemotherapy for patients with esophageal squamous cell carcinoma can degrade the clinical stage of tumor, reduce the risk of lymph node meta

关 键 词：新辅助化疗 食管癌 胸腹腔镜手术 

分 类 号：R735.1[医药卫生—肿瘤]