摘要
目的 探讨影响Ⅱ~Ⅲ期胸段食管鳞癌根治术后三维适形放疗（3D-CRT）预后的病理因素.方法 回顾性分析144例胸段食管鳞癌术后辅助3D-CRT患者的临床资料.采用Kaplan-Meier法计算生存率,并以Log rank检验进行单因素预后分析,Cox回归模型多因素预后分析.结果全组3、5 a总生存率分别为54.1%和45.0%,3、5 a无病生存率分别为51.1%、44.6%.中位生存期和无病生存期分别为46个月和42个月.单因素分析显示,脉管癌栓、肿瘤细胞分化程度、N分期、TNM分期和淋巴结引流区域转移组数是影响食管癌术后3D-CRT总生存率和无病生存的预后因素.Cox多因素分析结果显示,脉管癌栓（P=0.010）、肿瘤细胞分化程度（P=0.009）和N分期（P=0.014）是影响Ⅱ~Ⅲ期胸段食管癌术后3D-CRT总生存率的独立预后因素,而脉管癌栓（P=0.024）、N分期（P=0.001）和切缘（P=0.034）是影响Ⅱ~Ⅲ期胸段食管癌术后3D-CRT无病生存率的独立预后因素.结论 食管癌根治术后3D-CRT能降低局部复发率和提高生存率,脉管癌栓、肿瘤细胞分化程度、N分期是预测食管癌术后3D-CRT生存率的关键因素.
Objective To investigate the pathologic prognostic factors of three-dimensional conformal radiotherapy （3D-CRT）for patients with Ⅱ-Ⅲ stage esophageal squamous-cell carcinoma after radical esophagectomy. Methods The 144 patients with Ⅱ-Ⅲ stage thoracic esophageal carcinoma who had undergone radical esophagectomy were followed by 3D-CRT. The Kaplan-Meier method was used to calculate the survival rates, and the Log rank test was used for univariate analysis. The Cox proportional model was used for multivariate analysis. Results The 3- and 5-year overall survival rate of the patients were respectively 54.1% and 45.0%. The 3- and 5-year disease-free survival rate of the patients were respectively 51.1% and 44.6%. The median overall survival time was 46 months. The median disease-free survival time was 42 months. Univariate analysis showed that the significant prognostic factors included lymphovascular invasion, the grade of differentiation, N stage, TNM stage and lymphnode metastatic regions. In logistic multivariate analysis, lymphovascular invasion （ P =0. 010 ）, grade of differentiation （ P = 0. 009 ） and N stage （P = 0. 014）were the independent influencing factors closely correlating with the overall survival rate of postoperative 3 D-CRT for esophageal squamous-cell carcinoma; lymphnode metastatic regions （P = 0. 024）, N stage （P = 0.001 ）, incisal edge （P = 0.034）were the independent influencing factors closely correlating with the diseasefree survival rate of postoperative 3D-CRT for esophageal squamous-cell carcinoma. Conclusion Postoperative 3D- CRT can improve local control and survival in patients with esophageal squamous-cell carcinoma. Lymphovascular invasion, the grade of differentiation and N stage are the key predictive factors for survival of patients with esophageal squamous-cell carcinoma after postoperative 3D-CRT.
出处
《肿瘤基础与临床》
2013年第6期504-508,共5页
journal of basic and clinical oncology
基金
江苏省卫生厅医学科研项目(编号:H201350)
关键词
食管肿瘤
三维适形放疗
预后因素
esophageal neoplasms
three-dimensional conformal radiation therapy
prognosis
作者简介
宁忠华（1978-），男，硕士，主治医师，主要从事胸部及头颈部肿瘤放疗工作。E-mail：nzh96086@163．com
通讯作者：黄瑾（1965-），女，学士，主任医师，主要从事胸部及头颈部肿瘤放疗工作。E-hiail：huangjin@csco．org．cn
