食管癌锁骨上淋巴结转移放疗疗效及预后因素分析

目的 回顾性分析胸段食管癌锁骨上淋巴结转移患者的放疗疗效及其预后影响因素.方法回顾2005年1月-2009年12月经组织学证实的锁骨上淋巴结转移的胸段食管癌病例152例,其中食管原发灶采用放射治疗患者95例,手术治疗57例；食管原发灶治疗后锁骨上淋巴结转移81例,初诊时发现71例；141例患者锁骨上淋巴结行放射治疗,11例患者未行放射治疗.结果全组患者中位随访时间为17.5月(2～77月).放射治疗后近期疗效评价达CR、PR、NC及PD的分别为52.5％(74/141)、41.8％(59/141)、3.6％(5/141)和2.1％(3/141).1、2、3年生存率分别为51.3％、26.6％、17.3％.单侧转移与双侧转移患者1、3年生存率分别为54.0％、17.6％和26.7％、13.3％(P=0.033).转移灶放疗剂量≥60 Gy和＜60 Gy患者的1、3年生存率分别为61.5％、21.7％和12.5％、0(P＜0.01).单侧锁骨上区淋巴结转移的患者中,健侧锁骨上区预防照射与未行预防照射患者的1、3年生存率分别为53.7％、12.3％和56.3％、20.6％(P=0.939).多因素分析示患者的年龄、锁骨上淋巴结转移时间、锁骨上淋巴结转移时食管原发灶控制情况及是否合并内脏转移对预后的影响差异有统计学意义(P=0.007、P=0.009、P=0.008、P＜0.01).结论 放射治疗是食管癌锁骨上淋巴结转移的有效治疗手段；锁骨上转移灶放射治疗范围以累及野为宜,剂量60～70Gy；患者的年龄、锁骨上淋巴结转移时间、食管原发灶的控制情况及是否合并内脏转移对患者的预后有影响.

Analysis of Therapeutic Effect and Prognosis of Radiotherapy for Patients with Esophageal Carcinoma with Supraclavicular Lymph Node Metastasis

Objective
To explore the factors affecting the prognosis of radiotherapy for esophageal carcinoma with supraclavicular lymph
node metastasis.MethodsOne hundred and fifty-two esophageal carcinoma patients with supraclavicular lymph node
metastases who were admitted to the Fourth Hospital of Hebei Medical University from January 2005 to December 2009
were enrolled.A total of 95 patients with primary tumors received radiotherapy,whereas 57 patients underwent
surgery.Eighty one patients were found supraclavicular lymph nodes metastasis after the treatment of primary
esophageal carcinoma,and 71 patients were found with metastasis when they were diagnosed.A total of 141 patients
with supraclavicular lymph node metastasis received radiotherapy,whereas 11 did not.ResultsFollow-up time was 2 to
77 months with a median follow-up time of 17.5 months.After radiotherapy for the supraclavicular lymph-node,the rate
of CR,PR,NR and PD was 52.5%,41.8%,3.6% and 2.1% respectively.The 1-,2-,3-year overall survival rates were
51.3%,26.6% and 17.3%.The 1-year survival rates for one-side and both sides were 54.0% and 26.7%,and the 3-year
survival rates were 17.6% and 13.3% (P=0.033).The 1-,3-year survival rates of patients with supraclavicular lymph
nodes metastasis subjected the dose more than 60 Gy were 61.5%,21.7%,and that of less than 60 Gy were 12.5%,0%
(P<0.01),respectively.The 1-,3-year survival rates of patients with contralateral supraclavicular prophylactic
irradiation were 53.7%,12.3%,and that of without prophylactic irradiation were 56.3%,20.6 %
(P=0.939),respectively.Multivariate analysis revealed that age,time of supraclavicular lymphnode metastasis,whether
the primary tumors were controlled and visceral metastasis were independent factors for the survivals
(P=0.007,0.009,0.008,<0.01).ConclusionThe patients of esophageal carcinoma with supraclavicular lymph node
metastasis can benefit from radiotherapy.The suitable dose of supraclavicular lymph node was 60～70 Gy.Prophylactic
irradiation of contralateral supraclavicular region showed no advantage in prognosis.Age,the time of supraclavicular
lymph nodes enlargement with primary esophageal carcinoma,status of the primary tumor and visceral metastasis were
independent factors for the survival.