新辅助放化疗加手术治疗局部中晚期食管鳞癌的病理分析

目的探讨中晚期食管鳞癌新辅助放化疗加胸腔镜联合手术治疗后的病理特征、分级方法，寻找食管鳞癌预后不良的危险因素。方法2011年6月～2013年6月间浙江省台州医院共完成术前放化疗加胸腹镜联合手术治疗中晚期（ⅡB～ⅢA期）食管鳞癌22例。对食管肿瘤及送检淋巴结全部取材，进行病理分析。结果7例（31．8％）达到完全病理缓解（pCR），15例（61．2％）未达到完全病理缓解（非pCR）。在15例非pCR患者中，13例食管有肿瘤残留，6例有淋巴结转移，4例既有食管肿瘤残留又有淋巴结转移。2例患者术后短时间内发生远处转移并死亡，食管均有肿瘤残留且有淋巴结转移。结论TNM分期或G分期均适合于食管鳞癌新辅助放化疗加手术治疗后的病理分析，非pCR是食管鳞癌发生远处转移及预后不良的重要危险因素。根治性放化疗因可能遗漏较小的肿瘤或不能清除已经转移的淋巴结，可能对患者的预后造成不良影响。

The pathological assessment of the locally advanced esophageal carcinoma after neoadjuvant chemoradiotherapy and combined thoracoscopic and laparoscopic esophagectomy

Objective To study the clinicopathologic features, criteria for grading and prognostic factors of the locally advanced esophageal carcinoma after neoadjuvant chemoradiotherapy and combined thoracoscopic and laparoscopic esophagectomy （CTLE）. Methods From June 2011 to June 2013, 22 patients with locally advanced esophageal carcinoma undervent neoadjuvant chemoradiotherapy and CTLE. All the esophageal tumor and adjacent tissue were serially taken and analysed, the lymph node were completely taken and analysed. Results The 7 cases（31.8%） achieved patho- logical complete response （pCR）, 15 cases （61.2%） achieved non-pCR. In the cases who achieved non-pCR, 13 cases had gross or micropathologic residual tumor in the esophagus, 6 cases had lymphatic metastasis, 4 cases had both resid- ual tumor in the esophagus and lymphatic metastasis. 2 cases had distant metastasis and died soon after the surgery, both of which had residual tumor and lymph node metastasis. Conclusion TNM system or G system can be used in the clinicalpathologic analysis of the esophagea! carcinoma after neoadjuvant chemoradiotherapy and surgery . Non-pCR is an important risk factor of distant metastasis and adverse prognosis. High-dose chemoradiotherapy without surgery could omit little residual tumor or occult lymphatic metastasis and result a worse prognosis to the patients.