摘要
目的通过分析行食管癌三野淋巴结清扫根治术患者的单纯手术组与术后预防性放疗组局部复发的模式,评估术后放疗对局部控制的价值。方法收集本院2005～2010年行胸段食管癌三野淋巴结清扫根治术后局部复发的患者239例,分为单纯手术组(175例)与预防性放疗组(64例),分析比较二者局部复发模式的差异。结果 239例食管癌术后患者中,单纯手术组与预防性放疗组患者术后局部复发的类型均以淋巴结转移最为多见,分别占90.29%与95.31%;在淋巴结转移中均以纵隔淋巴结转移为多见。单纯手术组胸上段食管癌腹部淋巴结的复发显著低于胸中段及胸下段(χ2=9.452,P=0.009)。术后预防性放疗组的患者上纵隔淋巴结的复发显著低于单纯手术组(χ2=7.615,P=0.006)。而单纯手术组与术后预防性放疗组的颈部淋巴结复发(χ2=1.242,P=0.265)、中纵隔淋巴结的复发(χ2=0.023,P=0.880)、腹部淋巴结的复发(χ2=1.470,P=0.225)比较,差异均无统计学意义。结论颈部、上纵隔区、中纵隔区是胸段食管癌术后局部复发的主要部位。术后预防性照射上纵隔区对减少该部位的复发有很大价值,术后放疗靶区须包括上纵隔区。胸下段食管癌及原腹部淋巴结转移可能是腹部相应转移区域预防性放疗的指征。
Objective To analyze local-regional recurrence patterns of thoracic esophageal carcinoma after three-field lymph node dissection（3-FLD） with and without postoperative radiotherapy in order to assess the value of postoperative radiation for local control. Methods We reviewed local-regional recurrence patterns in 239 patients with thoracic esophageal squamous cell carcinoma treated with 3-FLD between 2005 and 2010.Of the 239 patients,64 received postoperative prophylactic radiotherapy and 175 did not. Results Recurrence in lymph nodes was 90.29% among patients who did not receive postoperative radiotherapy, and it was 95.31% among those who did.Rates of lymph node recurrence were highest in the mediastinal area, lower in the cervical area,and lowest in the abdominal area.Among patients who did not receive postoperative radiotherapy,the rate of abdominal lymph node recurrence was lower in the upper thoracic area than in the middle or lower thoracic areas（x2 =9.452,P=0.009）.The rate of recurrence in the superior mediastinal lymph node was higher among patients who did not receive radiotherapy than among those who did（x2 =7.615,P=0.006）. The two groups did not differ significantly in recurrence rates at the cervical lymph nodes（x2 =1.242,P=0.265）,mediastinal lymph nodes （x2 =0.023,P=0.880）,or abdominal lymph nodes （x2 =1.470, P=0.225）. Conclusions Risk of recurrence is greatest in superior,middle mediastinum and neck lymph nodes in patients with thoracic esophageal carcinoma after 3-FLD.Postoperative radiotherapy reduces the risk of recurrence in the superior mediastinal lymph nodes, and the felds of these lymph nodes should be delineated as the postoperative prophylactic irradiation target volume.Metastasis to lower thoracic and abdominal lymph nodes may be an indication for irradiating the corresponding abdominal lymph node region.
出处
《中国癌症防治杂志》
CAS
2012年第4期331-335,共5页
CHINESE JOURNAL OF ONCOLOGY PREVENTION AND TREATMENT
关键词
食管肿瘤
手术
局部复发
术后放疗
Esophageal neoplasms
Surgery
Recurrence
Postoperative radiotherapy
作者简介
【通信作者】潘建基。E—mail：panjianji@126．com
