食管癌术后淋巴结转移对生存率的影响和放射治疗的意义  

Influence of the number of lymph node metastasis on survival and significance of postoperative radiotherapy for esophageal carcinoma

作　　者：肖泽芬[1] 杨宗贻[1] 王绿化[1] 张红星[1] 冯勤富[1] 陈东福[1] 周宗玫[1] 张德超[2] 孙克林[2] 程贵余[2] 赫杰[2] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤研究所肿瘤医院放射治疗科,北京100021 [2]中国医学科学院中国协和医科大学肿瘤研究所肿瘤医院胸外科,北京100021

出　　处：《中华肿瘤杂志》2004年第2期112-115,共4页Chinese Journal of Oncology

摘　　要：目的　分析淋巴结转移个数对生存率的影响及放射治疗的意义。方法　 4 95例食管癌根治性手术切除患者 ,随机分为单一手术组 (2 75例 )和术后放疗组 (2 2 0例 ) ,根据淋巴结转移的个数分为 3组 :A组无淋巴结转移 ,占 4 7.2 % ;B组淋巴结转移个数 1～ 2枚 ,占 2 9.5 % ;C组淋巴结转移个数≥ 3枚 ,占 2 3.2 %。结果　 (1)相同T分期 (T3)时 ,A、B、C三组的 5年生存率分别为 5 2 .6 %、2 8.8%和 10 .9(P =0 .0 0 0 0 ) ;在C组 ,单一手术和术后放疗者的 5年生存率分别为 0和 19.3% (P =0 .0 336 )。 (2 )在淋巴结阳性组 (B +C组 ) ,单一手术和术后放疗者的胸内淋巴结转移率分别为 35 .9%和 2 1.2 % (P =0 .0 14 ) ,锁骨上淋巴结转移率分别为 19.7%和 4 .4 % (P =0 .0 0 0 ) ;在淋巴结阴性组 (A组 ) ,单一手术和术后放疗的胸内淋巴结转移率分别为 2 7.8%和 10 .3% (P =0 .0 0 3) ;A、B、C三组的腹腔淋巴结转移率分别为 3.9%、9.4 %和 17.5 % (P =0 .0 0 0 )。血行转移率以C组最高 ,为 2 7.8%。结论　淋巴结转移个数是影响食管癌生存率的因素之一。淋巴结转移个数≥ 3枚时 ,血行转移率高 ,是全身化疗的指征。术后放疗降低了放疗部位淋巴结转移率 ,明显提高了C组生存率。Objective To analyze the influence of the number of lymph node metastasis on survival and prophylactic postoperative radiotherapy after radical resection of thoracic esophageal carcinoma. Methods Four hundred and ninety-five patients with thoracic esophageal squamous cell cancer who had undergone radical resection were randomly divided into surgery group alone (S, 275) and surgery plus radiotherapy group (S+R, 220). The patients were classified into three groups: Group A: 234 patients (47.2%) without lymph node involvement; Group B: 146 patients (29.5%) with 1 to 2 involved lymph nodes and Group C: 115 patients (23.2%) with ≥3 involved lymph nodes. Results 1. The 5-year survival rate in Groups A、B and C for the same T stage (T3) was 52.6%, 28.8% and 10.9%, respectively (P=0.0000); the 5-year survival rate in group C was 0% in S group and 19.3% in S+R group (P=0.0336); 2. In the positive lymph node group, the metastatic rate of intra-thoracic and supraclavicular lymph node was 35.9% and 21.2% in S group and 19.7% and 4.4% in S+R group (P=0.014 and P=0.000). In the negative lymph node group, the metastatic rates of intra-thoracic lymph node was 27.8% in S group and 10.3% in S+R group (P=0.003). The metastatic rate of intra-abdominal lymph node in Groups A, B and C was 3.9%, 9.4% and 17.5%, respectively (P= 0.0000). The occurrence of hematogenous metastasis was most frequent in group C(27.8%) with≥3 positive lymph nodes. Conclusion 1. The number of metastatic lymph node is one of the important factors which affects the survival of thoracic esophageal carcinoma. 2. Chemotherapy might be given to the patients with three or more lymph nodes involved who have the possibility of developing hematogenous metastasis. Postoperative radiotherapy can reduce the occurrence of intra-thoracic and supraclavicular lymph node metastasis and improve the survival of patients with three or more lymph nodes involvement.

关 键 词：食管癌术 淋巴结转移 生存率 放射治疗 手术 

分 类 号：R735.1[医药卫生—肿瘤]