Ⅱ、Ⅲ期胸段食管鳞癌术后不同辅助治疗方式的疗效分析

目的 评价术后联合放化疗(S+CRT)或术后放疗(S+RT)对Ⅱ、Ⅲ期胸段食管鳞癌患者疗效和不良反应。方法 收集2007—2010年间行根治术且术后辅助放疗或放化疗的Ⅱ、Ⅲ期胸段食管鳞癌215例患者资料。Kaplan-Meier法计算生存率并Logrank法检验和单因素预后分析,Cox模型多因素预后分析。结果 S+CRT与S+RT组资料具有可比性(P=0.055~0.988)。随访满1、3、5年者分别为203、133、108例。全组患者1、3、5年OS和DFS分别为94.0%、61.4%、49.3%和74.9%、53.5%、46.7%。患者术前CT显示纵隔淋巴结肿大、术中食管病变与周边组织器官粘连程度、病理N分期、脉管瘤栓、阳性淋巴结个数和治疗方式均为OS影响因素(P=0.000~0.034),患者术前CT显示纵隔淋巴结肿大、术中食管病变与周边组织器官粘连程度、术后残端是否阳性、阳性淋巴结个数和治疗方式均为DFS影响因素(P=0.000~0.049)。S+CRT组OS、DFS均优于S+RT组(P=0.002、0.002)。分层分析显示Ⅱ期患者S+CRT组OS、DFS均高于S+RT组(P=0.041、0.001);N₁期患者S+CRT组OS、DFS也均高于S+RT组(P=0.021、0.024)。S+CRT组≥2级放射性胃炎及骨髓抑制发生率均高于S+RT组(P=0.000、0.015)。结论 Ⅱ、Ⅲ期胸段食管鳞癌术后患者接受S+CRT及S+RT均具有较好疗效;S+CRT较S+RT能提高Ⅱ期和N₁期患者OS与DFS;S+CRT组不良反应较大但患者均可耐受;但最终结论需前瞻性Ⅲ期随机研究证实。     

Clinical benefit of chemosensitivity test for patients with regional lymph node-positive esophageal squamous cell carcinoma

BACKGROUND AND OBJECTIVES: Patients who have undergone resection for lymph node-positive esophageal squamous cell carcinoma are at high risk of recurrence and early death. The role of the postoperative adjuvant chemotherapy in this population needs to be determined. The present study was designed to determine whether the chemosensitivity test in fresh human esophageal squamous cell carcinoma, using highly purified tumor cells, correlates with the clinical response. METHODS: A retrospective review of all patients with resected squamous cell carcinoma of the thoracic esophagus between 1993 and 2000 was performed. We determined the chemosensitivity for cisplatin (CDDP), 5-fluorouracil (5-FU), mitomycin C, and adriamycin in vitro in fresh human esophageal squamous cell carcinoma using the MTT assay. Regional lymph node-positive (N1) patients who received sequential postoperative chemotherapy were compared with lymph node positive patients who underwent surgery alone. RESULTS: A total of 50 patients were reviewed, and chemosensitivity tests were successfully performed in 46 patients: 20 patients received surgery alone (S group), and 26 patients received surgery plus postoperative chemotherapy (SC group) according to results of MTT assay using highly purified tumor cells. When the SC group was divided into an SC-low group (inhibition rate of CDDP + 5-FU was below 85%, n = 15) and an SC-high group (over 85%, n = 11), the SC-high group showed more significant survival prolongation than the S group or the SC-low group (P < 0.01). CONCLUSIONS: Our results suggest that the results of the conventional MTT assay may be useful in evaluating the optimum adjuvant chemotherapy for patients with regional lymph node positive (pN1) esophageal squamous cell carcinoma.     

Influence of number of metastatic lymph nodes on survival of curative resected thoracic esophageal cancer patients and value of radiotherapy: report of 549 cases

PURPOSE: To analyze the significance of the number of metastatic lymph nodes on survival with and without the addition of prophylactic postoperative radiotherapy (RT) after radical resection of thoracic esophageal carcinoma. METHODS AND MATERIALS: A total of 549 thoracic esophageal squamous cell cancer patients who had undergone radical resection were randomized by the envelope method into a surgery-alone group (S, n = 275) and a surgery plus RT group (S+R, n = 274). We performed a retrospective review of all patients according to the extent of metastasis. The patients were classified into three groups: Group 1, 269 patients (49.0%) without lymph node involvement; Group 2, 159 patients (29.0%) with one to two positive nodes; and Group 3, 121 patients (22.0%) with three or more positive lymph nodes. RESULTS: For the same T stage (T3), the 5-year survival rate for Groups 1, 2, and 3 was 50.6%, 29.3%, and 11.7%, respectively (p = 0.0000). For patients with Stage III, the 5-year survival rate for Groups 1 (T4N0M0), 2 (T3-T4N1M0), and 3 (T3-T4N2M0) was 58.1%, 30.6%, and 14.4%, respectively (p = 0.0092). The 5-year survival rate of the S and S+R groups with positive lymph nodes (Groups 2 and 3) was 17.6% and 34.1% (p = 0.0378). In the positive lymph node groups, the incidence of failure by intrathoracic lymph node metastasis and supraclavicular lymph node metastasis in the S+R group (21.5% and 4.6%, respectively) was lower than in the S group (35.9% and 19.7%, respectively; p <0.012). In the negative lymph node group, the incidence of failure by intrathoracic lymph node metastasis in the S and S+R groups was 27.8% and 13.3%, respectively (p = 0.006). Hematogenous metastasis was the greatest (27.5%) in Group 3 (three or more positive lymph nodes). CONCLUSION: The number of metastatic lymph nodes is one of the important factors affecting the survival of patients with thoracic esophageal carcinoma. In our study, postoperative RT improved the survival of patients with positive lymph nodes. Additionally, postoperative RT reduced the incidence of intrathoracic recurrence and supraclavicular lymph node metastasis for all patients.     

胸段食管癌手术治疗后的死因与复发类型

背景与目的：食管癌的死因包括局部浸润和／或远处转移，手术的介入会对死因产生影响。本研究对食管癌术后死亡时的复发类型及死亡原因进行总结，分析食管癌死亡时间以及导致食管癌死亡的危险因素。方法：1999年6月-2004年6月手术治疗后确诊死亡的食管癌80例，收集临床病理资料。用Spearnmn法进行各个临床因素与复发类型、生存时间的相关分析；用Kaplan—Meier法绘制生存曲线，以log—rank比较各因素埘死亡时间的影响：结果：全组一年内死亡为49例（61．3％），2年内死亡为67例（83．8％）。死亡原因为纵隔内复发16例（20％），淋巴道转移30例（37．5％），血道转移为34例（42．5％）。行淋巴结清扫的复发类型以血道转移为主，与淋巴结采样的相比有明显差异，P〈0．01；纵隔内复发、淋巴道转移与血道转移3组患者的生存时间无显著区别。64例肿瘤完全切除的患者，淋巴结阴性的比阳性的生存时间长（P=0．0468）。淋巴结采样的一年内死亡比淋巴结清扫的明显多，P=0．02；姑息切除的无一例活过2年。结论：血道转移、纵隔内复发及淋巴道复发都是引起食管癌死亡的重要原因，而复发类型与淋巴结切除程度有关：食管癌的完全切除及淋巴结清扫可降低局部复发，减少因局部及区域复发而导致的死亡。     

放化疗中不同化疗方式对N3期鼻咽癌预后影响

目的 评价放化疗中不同方式化疗对N3期鼻咽癌患者预后的影响.方法 回顾分析114例N3期鼻咽癌患者资料.9例接受单纯放疗;105例接受以铂类为基础化疗联合放疗,其中同期放化疗37例,诱导化疗+同期放化疗53例,同期放化疗+辅助化疗15例.鼻咽原发灶采用60Co γ线、6 MV X线常规分割照射70 Gy,颈部根治量60～68 Gy,颈部预防量54～60 Gy.结果 中位随访时间54个月,共51例患者死亡.全组5年总生存率为59.1%.单纯放疗、同期放化疗、诱导化疗+同期放化疗、同期放化疗+辅助化疗的5年总生存率分别为17%、51%、68%、71%(X2=15.44,P=0.001),无复发生存率分别为83%、77%、88%、93%(X2=2.34,P:0.505),无转移生存率分别为17%、54%、72%、80%(X2=19.28,P=0.000).结论 诱导化疗+同期放化疗及同期放化疗+辅助化疗方式对N3期鼻咽癌患者比单纯同期放化疗更具优势,最有效治疗方式有待随机研究证实.

Abstract：

Objective Nasopharyngeal carcinoma patients with stage N3 disease are prone to develop distant metastasis even treated with standard concurrent chemoradiotherapy(CRT).The aim of this study is to compare the ettlcacy of difierent chemotherapy sequences in these patients.Methotis All patients with histologically proven,carcinoma of the nasopharynx treated between July 1999 and November 2003 were restaged according to the AJCC 2002 stage classification system.A total of 114 patients had AJCC N3 diseases were analyzed retrospectively.Patients were treated by conventional RT technique using 6 MV photons or 60 Coγ-ray with 1.8-2.0 Gy per fraction,5 fractions a week,to a planned dose of 70 Gy.The prophylactic irradiation dose of the neck wss 54-60 Gy.Any positive lymph node was boosted to a total dose of 60-68 Gy.All patients received cisplatin-based chemotherapy of difierent sequences but 9 patients RT alone.CRT regimen was delivered in 37 patients,neoadjuvant chemotherapy(NACT)+CRT regimen in 53 patients and CRT+adjuvant chemotherapy(AC)regimen in 15 patients.Results The prophylactic irradiation dose of the neck wss 54-60 Gy.Any positive lymph node was boosted to a total dose of 60-68 Gy.All patients received cisplatin-based chemotherapy of difierent sequences but 9 patients received RT alone.CRT regimen was delivered in 37 patients,neoadjuvant chemotherapy(NACT)+CRT regimen in 53 patients and CRT+adjuvant chemotherapy(AC)regimen in 15 patients.Results The median follow up time was 54 months(3-117months).The 5-year overall survival rate was 59.1%in whole groups,and with 17%,51%,68%and 71%in RT,CRT,NACT+CRT and CRT+AC group,respectively(X2=15.44,P=0.001).The 5-year relapse-free survival rates were 83%,77%,88%and 93%in RT,CRT,NACT+CRT and CRT+AC group,respectively(X2=2.34,P=0.505).The 5-year metastasis-free survival rates were 17%,54%,72%and 80%in RT,CRT,NACT+CRT and CRT+AC group,respectively(X2=19.28,P=0.000).Conclusions The NACT+CRT and CRT+AC regimens were more effective than CRT alone for N3 disease in the current study.Large prospective,randomized clinieal studies are warranted.     

胸中段食管鳞癌根治术后腹腔淋巴结复发因素分析及术后放疗指导意义

目的 分析胸中段食管鳞癌根治术后腹腔淋巴结复发危险因素,并依据结果讨论术后放疗靶区设计方案。方法 对2007—2012年间收治的 913例胸中段食管鳞癌根治性术后患者进行回顾分析,分析影响患者治疗后出现腹腔淋巴结复发的因素,并比较高危人群不同治疗方式的疗效。对计数资料行χ²检验,Kaplan-Meier法计算OS并Logrank单因素分析,Logistic多元回归方程分析与腹腔淋巴结复发相关影响因素。结果 疗后 37例出现腹腔淋巴结复发,复发率为4.1%;复发部位共53个。单因素分析结果显示未/低分化鳞癌、pT3+4期、术后病理阳性淋巴结数≥3个和术后显示腹腔淋巴结阳性为影响腹腔淋巴结复发因素(P=0.032、0.001、0.009、0.000)。多元回归分析病理T分期、术后病理显示腹腔淋巴结阳性为影响腹腔淋巴结复发因素(P=0.011、0.000)。术后放疗可以提高术后腹腔淋巴结阳性和pT3+4期患者OS和LC,而对降低DMFS作用有限。结论 T分期和术后腹腔淋巴结阳性为胸中段食管鳞癌患者根治术后腹腔淋巴结复发的重要危险因素,建议对pT3+T4期期和术后病理显示腹腔淋巴结阳性患者进行术后辅助治疗。     

胸段食管癌转移淋巴结数量与生存率关系的研究

目的 探讨胸段食管癌转移淋巴结数最与食管癌预后的关系.方法 分析1995年7月至2005年7月在山西省肿瘤医院行胸段食管癌根治术的患者1140例的临床资料,并进行生存情况分析.结果 淋巴结转移数量与食管癌的生存率呈负相关(P=0.000);患者淋巴结切除数量≥8枚、<8枚时,淋巴结转移度差异有统计学意义(P=0.000).结论 食管癌淋巴结转移数量与患者预后呈显著相关性,能反映其预后,建议pTNM分期将淋巴结转移数考虑在N1内.     

第7版食管癌锁骨上淋巴结转移分期方式的探讨及152例病例分析

分析食管癌锁骨上淋巴结转移放疗疗效及探讨第7版国际食管癌M分期方式。方法:回顾分析2005年1月至2009年12月经病理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的患者81例,首诊时发现71例;141例患者锁骨上淋巴结行放射治疗,11例未行放射治疗。结果:全组患者中位随访时间为17（2～68）个月。放射治疗后近期疗效评价52.5%的患者达CR（74/141）、41.8%达PR（59/141）、3.6%达NC（5/141）、2.1%达PD（3/141）。至随访截止日期生存者40例,1、2、3年生存率分别为69.1%、37.4%、24.0%。多因素分析显示年龄、锁骨上淋巴结转移时间、单侧或双侧转移、近期疗效及是否合并内脏转移对预后的影响有统计学意义（P<0.05）。根据第7版国际食管癌TNM分期按食管原发灶首诊时有无胸腔内及锁骨上区淋巴结转移分为N分期（39例）和M分期（71例）组,两组患者1、2、3年总生存率分别为82.1%、54.1%、31.0%和56.3%、28.1%、21.7%（P=0.041）。按照第6版国际食管癌TNM分期,根据患者食管原发灶首诊时有锁骨上区淋巴结转移的M分期组71例分为M1a 20例与M1b 51例,两组患者1、2、3年总生存率分别为60.0%、27.3%、27.3%和54.9%、28.7%、19.0%,（P=0.930）。单纯锁骨上淋巴结转移（104例）与合并内脏转移（48例）患者的1、2、3年生存率分别为72.1%、47.0%、32.9%和62.5%、17.5%、5.8%（P<0.001）。结论:胸段食管癌出现锁骨上淋巴结转移与胸腔内淋巴结转移患者生存情况存在显著性差异;单纯锁骨上淋巴结转移与合并内脏器官转移患者的预后有显著性差异,分期时是否应将锁骨上淋巴结转移划分为M分期或N分期,还是分亚组需进一步研究;原发灶的位置对食管癌锁骨上淋巴结转移的预后影响不大;患者的年龄、锁骨上淋巴结转移时间、单侧或双侧转移、近期疗效及是否合并内脏转移对预后有影响。      

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

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 495例食管癌根治性手术切除患者,随机分为单一手术组(275例)和术后放疗组(220例),根据淋巴结转移的个数分为3组：A组无淋巴结转移,占47．2％;B组淋巴结转移个数1～2枚,占29．5％;C组淋巴结转移个数≥3枚,占23．2％。结果(1)相同T分期(T3)时,A、B、C三组的5年生存率分别为52．6％、28．8％和10．9(P=0．0000);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=0．0336)。(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21．2％(P=0．014),锁骨上淋巴结转移率分别为19．7％和4．4％(P=0．000);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27．8％和10．3％(P=0．003);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=0．000)。血行转移率以C组最高,为27．8％。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。     

基于IMRT和RTOG颈部淋巴结分区标准的鼻咽癌N分期研究

目的 建立一个基于IMRT和RTOG颈部淋巴结分区标准的鼻咽癌新N分期。 方法 回顾分析广西医科大学第一附属医院2010—2011年经病理学证实、无DM并接受IMRT的初治鼻咽癌患者324例,根据鼻咽癌UICC/AJCC分期标准(第7版)进行重新分期。Kaplan-Meier法计算生存率,Logrank法单因素预后分析,Cox模型多因素预后分析。 结果 324例患者中269例(83.0%)出现转移淋巴结,中位随访58个月(6~77个月),全组5年OS率为84.8%,DFS率为77.1%,RFS率为92.7%,DMFS率为80.5%。对其中颈部淋巴结阳性患者预后因素分析显示咽后淋巴结、颈部淋巴结水平、侧数是影响鼻咽癌患者预后因素(P值均<0.05)。根据风险比差异确定鼻咽癌新N分期: N₀期为无淋巴结转移;N₁期为Ⅶ_a区或/和单侧上颈(Ⅰ、Ⅱ、Ⅲ、V_a区)淋巴结转移;N₂期为双侧上颈(Ⅰ、Ⅱ、Ⅲ、Ⅴ_aa区)淋巴结转移;N₃期为Ⅳ _a、Ⅴ_b区及以下区域淋巴结转移。 结论 基于IMRT和RTOG颈部淋巴结分区标准的鼻咽癌新N分期更符合现状,并能更客观预测预后、指导治疗。     

不同淋巴结清扫范围对Ⅲ期食管癌患者术后生存的影响

目的 探讨不同淋巴结清扫范围对Ⅲ期胸中段食管痛患者牛存率的影响,评价其安全性及可行性.方法 收集122例行完全性切除术的Ⅲ期胸中段食管癌患者的临床和随访资料,按照手术方式分为二野淋巴结清扫组(62例)和二野淋巴结清扫组(60例).采用寿命表法比较两组患者的牛存率,Kaplan-Meier法单因素分析全组患者凶病理分期、淋巴结清扫方式等不同而产生的生存差异,Cox多因素分析影响患者生存的主要因素.结果 两组患者的一般资料具有可比性.二野和三野淋巴结清扫组患者的并发症发生率分别为14.5%和15.0%,围手术期死亡率分别为1.6%和1.7%,差异均无统计学意义(均P＞0.05).二野淋巴结清扫组患者的术后1、3、5年生存率分别为78.2%、39.6%和14.5%,中位生存期为24个月;三野淋巴结清扫组患者的术后1、3、5年生存率分别为83.7%、42.4%和18.1%,中位生存期为31个月.在122例Ⅲ期胸中段食管癌患者中,术前体重下降不明显、术后病理分期为T3N1M0、仅有1个区域淋巴结转移且淋巴结转移数＜3枚、行三野淋巴结清扣术的患者预后较好(P＜0.05).多因素分析显示,T分期、N分期和淋巴结清扫方式是影响Ⅲ期胸中段食管癌患者预后的危险因素(P＜0.05).结论 三野淋巴结清扫能提高Ⅲ期胸中段食管癌患者的生存率,且并未增加并发症的发生率和围手术期死亡率,是安全可行的.     

Surgery plus chemotherapy compared with surgery alone for localized squamous cell carcinoma of the thoracic esophagus: a Japan Clinical Oncology Group Study--JCOG9204.

PURPOSE: We performed a multicenter randomized controlled trial to determine whether postoperative adjuvant chemotherapy improves outcome in patients with esophageal squamous cell carcinoma undergoing radical surgery. PATIENTS AND METHODS: Patients undergoing transthoracic esophagectomy with lymphadenectomy between July 1992 and January 1997 at 17 institutions were randomly assigned to receive surgery alone or surgery plus chemotherapy including two courses of cisplatin (80 mg/m2 of body-surface area x 1 day) and fluorouracil (800 mg/m2 x 5 days) within 2 months after surgery. Adaptive stratification factors were institution and lymph node status (pN0 versus pN1). The primary end point was disease-free survival. RESULTS: Of the 242 patients, 122 were assigned to surgery alone, and 120 to surgery plus chemotherapy. In the surgery plus chemotherapy group, 91 patients (75%) received both full courses of chemotherapy; grade 3 or 4 hematologic or nonhematologic toxicities were limited. The 5-year disease-free survival rate was 45% with surgery alone, and 55% with surgery plus chemotherapy (one-sided log-rank, P =.037). The 5-year overall survival rate was 52% and 61%, respectively (P =.13). Risk reduction by postoperative chemotherapy was remarkable in the subgroup with lymph node metastasis. CONCLUSION: Postoperative adjuvant chemotherapy with cisplatin and fluorouracil is better able to prevent relapse in patients with esophageal cancer than surgery alone.     

局部晚期食管鳞状细胞癌术后放疗和化疗的前瞻性研究

目的 评价局部晚期食管鳞状细胞癌(FSCC)手术后放射治疗和化疗的疗效.方法 将1997年1月至2004年6月间入院的158例ESCC(Ⅱ-Ⅲ期)患者随机分为术后放化疗组(78例)和单纯手术组(80例).后经微调和排查,实际术后放化疗组为74例,单纯手术组为77例.对比两组患者的并发症发生率、局部复发率和远处转移率、生存率及无进展生存率.结果 患者平均随访45个月,术后放化疗组的并发症发生率与单纯手术组比较,差异无统计学意义(P>0.05).术后放化疗组局部复发和远处转移率低于单纯手术组(P<0.05).术后放化疗组的中位生存时间(53.5个月)与单纯手术组(37个月)比较,差异有统计学意义(P<0.05),两组的1年生存率比较,差异无统计学意义(P>0.05),但3、5和10年生存率比较,术后放化疗组优于单纯手术组(P<0.05).术后放化疗组的中位无进展生存期(46个月)与单纯手术组(34个月)比较,差异有统计学意义(P<0.05),两组1年无进展生存率比较,差异无统计学意义(P>0.05),但3、5和10年无进展生存率比较,术后放化疗组优于单纯手术组(P<0.05).结论 术后合理应用放化疗可有效提高局部晚期ESCC患者的无进展生存时间及长期生存率.     

T4b期胸段食管鳞癌同期放化疗疗效分析

目的 研究拟分析T4b期食管鳞癌接受同期放化疗的临床疗效及治疗并发症,并探讨临床相关因素对预后的影响。方法 回顾分析我院2010-2015年接受同期放化疗的143例T4b期胸段食管鳞癌患者,其中71%患者肿瘤侵犯气管或支气管,44%侵犯胸主动脉或大血管。放疗中位剂量为60 Gy (44~68 Gy),常规分割,其中69例(48%)采用3DCRT,余74例(52%)采用IMRT;化疗均采用以铂类为基础的化疗方案。根据Kaplan-Meier法进行生存分析,Logrank检验差异,Cox回归模型进行多因素分析。结果 全组患者的中位生存期为12.2个月,2、3年生存率分别为34%、29%。51例(36%)患者在治疗期间或放疗后3个月内发生≥2 级严重并发症,包括食管瘘42例、肺炎6例、食管出血3例。发生、未发生严重并发症患者的中位生存期分别为6.9、20.4个月(P<0.01)。多因素分析显示TNM分期、是否出现严重并发症是影响总生存的独立预后因素。结论 T4b期胸段食管鳞癌同期放化疗的疗效满意,但出现≥2级严重并发症的风险很高。     

Localization of initial lymph node metastasis from carcinoma of the thoracic esophagus

BACKGROUND: Most surgeons consider esophageal carcinoma with lymph node involvement a systemic disease. However, it is possible that the disease may be localized in the earlier phases of lymphatic metastasis. The distribution of involved lesions in the initial phase of lymph node metastasis has not been thoroughly investigated yet. METHODS: Among 329 patients that underwent curative (R0 International Union Against Cancer [UICC]) esophagectomy with systematic mesoesophageal dissection, 51 cases of patients with only 1 involved lymph node (solitary involvement) were retrospectively investigated and compared with patients with multiple involved lymph nodes. The regional lymph nodes were divided into the thoracocervical junction group (lower deep cervical and recurrent nerve lymph nodes), perigastric group, and intrathoracic group. RESULTS: Lymph node involvement was limited to a solitary lymph node in 46% of lymph node positive patients with esophageal carcinoma confined to the wall (T1 and T2, UICC) and in 17% of lymph node positive patients with cancer that invaded the extramural layer (T3 and T4, UICC). Of patients with solitary involvement, 82% had a positive thoracocervical junction or perigastric lymph node. The 5-year survival rate in solitary involvement cases was 61%, and 65% when solitary involvement was not intrathoracic. Most of the 5-year survivors had involvement of a thoracocervical junction or perigastric lymph node and had not received systemic chemotherapy. CONCLUSIONS: Solitary involvement was not rare and not directly associated with a disseminated disease. Solitary involvement was commonly located in the thoracocervical junction or abdomen that are accessible without thoracotomy. Systematic dissection of the regional lymph nodes including thoracocervical junction and perigastric groups is recommended for resectable esophageal carcinoma at this time. However, less extensive dissection may be performed in selected cases if the sentinel lymph node concept proves valid.     

食管鳞癌术后局部区域复发患者接受不同照射方式获益人群的初步分析

目的 探讨胸段食管鳞癌患者术后局部区域复发接受放疗患者不同照射方式的人群获益情况。方法 回顾性分析2009-2014年间河北医科大学第四医院 344例食管癌术后复发接受了调强适形放疗或同步化放疗患者的病历资料,分析患者的复发部位分布的情况、预后影响因素,并对接受选择性淋巴结照射(ENI)和累及野照射(IFI)两种方式的获益人群进行分层分析。结果 术后单区域复发 276例(80.2%),其中≥2个区域复发 68例(19.8%)。随访率96.2%。全组患者1、3、5年总生存率分别为53.6%、22.6%、16.4%,中位生存期12.8个月(95%CI为 11.3~14.3个月);1、3、5年无局部复发生存率分别为46.5%、16.9%、12.0%,中位生存期11.0个月(95%CI为 9.6~12.4个月);1、3、5年无进展生存率分别为39.8%、11.3%、6.7%,中位生存期7.9个月(95%CI为 5.8~10.0个月)。全组多因素分析结果显示患者性别、阳性淋巴结对数比(LODDS)、化疗周期数均为患者预后的独立影响因素(P=0.003、<0.001、<0.001)。亚组单因素分析结果显示对食管病变长度<5.0cm、N0期、手术清扫淋巴结≤9个、术后阳性淋巴结转移区域数为0个、LODDS≤0.030患者进行ENI可使其受益(P=0.032、0.012、0.001、0.012、0.014);而对手术清扫淋巴结≥16个患者进行IFI可使其获益(P=0.035)。结论 放疗为食管癌术后局部区域复发患者的有效治疗模式,对于术前食管造影显示食管病变较短、术后病理N分期较早、LODDS评分较低和清扫淋巴结数目较少者可能应用ENI较IFI更能使其获益;而术中清扫淋巴结数目较多患者可能应用IFI较ENI更能使其获益。     

The effectiveness of planned esophagectomy after neoadjuvant chemoradiotherapy for advanced esophageal carcinomas

BACKGROUND: The best treatment option for patients with locally advanced esophageal carcinoma has not yet been determined, especially because the benefits of esophagectomy after neoadjuvant chemoradiotherapy are still controversial. We report the results of a retrospective cohort comparison of definitive chemoradiotherapy without surgery (CRT) versus neoadjuvant chemoradiotherapy followed by planned surgery (CRTS) in patients with advanced esophageal squamous cell carcinoma (SCC). MATERIALS AND METHODS: Between January 1991 and December 2002, 67 patients were enrolled in this study. Fifty of the 67 patients were considered to have inoperable tumors due to distant organ metastasis, distant lymph node metastasis, severe organ dysfunction or rejection of surgery by the patient and received CRT, while the remaining 17 patients were treated with CRTS. The clinical responses of the primary tumors were evaluated. RESULTS: In the 50 CRT patients, the one- and 2-year survival rates were 33.8% and 20.2%, respectively, and the median survival time (MST) was 13.5 months. In the 17 CRTS patients, the response rate (CR + PR) was 76.5%, and the pathological complete response (pCR) rate was 29.4%. Their one- and 2-year survival rates were 61.6% and 35.9%, respectively, and the MST was 24.4 months. The survival rates of the CRT patients were lower than those of the CRTS patients (p = 0.1288). When the 12 patients with distant organ metastases were removed from the CRT group, the one- and 2-year survival rates of the remaining 38 patients were 36.5% and 24.1%, respectively, and the MST was 14.7 months. The survival rates of these 38 CRT patients without distant organ metastases were similar to those of the 12 CRTS patients in the pathological partial response (pPR) group (p = 0.6279). CONCLUSION: This retrospective cohort comparison of CRT versus CRTS demonstrated that there may not be any survival benefit from the addition of surgery in the pPR group for advanced esophageal carcinomas. For patients with a poor response to neoadjuvant chemoradiotherapy, we suggest that the addition of chemoradiotherapy, instead of planned esophagectomy, may show a similar survival rate to definitive CRT. Thus, a large series of a randomized control study will be required to confirm the benefit of surgery after chemoradiotherapy.     

91例术后局部复发转移食管癌放疗疗效和预后分析

目的 探讨食管癌术后局部复发转移的放疗疗效和预后影响因素.方法 回顾性分析食管癌术后局部复发转移行放疗的91例患者资料,术后复发时间为1～35个月,中位数为11.1个月.吻合口复发4例,纵隔淋巴结转移+吻合口复发6例;腹腔淋巴结转移4例,锁骨上淋巴结转移20例,纵隔淋巴结转移34例,锁骨上区+纵隔淋巴结转移23例.常规放疗56例,三维适形放疗35例,剂量50～70 Gy.68例联合化疗1～4个周期.结果 随访率为95%.1、2、3年生存率分别为52%、20%和14%.Logrank单因素分析显示术后复发时间、术后临床分期、放疗剂量、近期疗效、术后T分期、术后N分期与预后相关(P=0.001、0.000、0.001、0.000、0.028、0.003).Cox多因素分析结果显示术后复发时间、术后临床分期、放疗剂量、近期疗效是独立预后因素(P=0.014、0.006、0.009、0.000).结论 食管癌术后局部复发转移患者放疗可以延长部分患者生存时间,术后复发时间长、术后分期早、放疗后近期疗效好、放疗总剂量≥60 Gy者预后较好.     

食管癌根治术后三维放疗患者预后的影响因素分析

目的探讨食管癌根治术后行三维放疗患者生存的影响因素。方法回顾分析2005年1月至2009年12月常州市第一人民医院收治的食管癌根治术后行三维放疗的114例患者的临床资料。采用 Kaplan Meier 生存分析法和log rank统计检验各临床病理特征与食管癌根治术后辅助放疗患者预后的相关性。结果114例患者术后放疗后3、5年总体生存率分别为57%和42%;Kaplan Meier生存分析法和log rank统计检验方法分析显示淋巴结转移阳性、淋巴结转移区域数目较多、TNM分期越高、脉管癌栓阳性和Ki 67高表达的食管癌根治术后放疗患者的预后较差,反之则患者预后较好。结论淋巴结转移、淋巴结转移区域数目、TNM分期、脉管癌栓和Ki 67表达是食管癌术后放疗患者生存的影响因素。     

单中心非转移性男性乳腺癌临床病理特征和生存分析

Heʼnan Medical Team has stationed in Lin county(now Linzhou City) of Heʼnan Province for 60 years since November 1959 to carry out prevention and treatment research on high incidence of esophageal cancer. In the past 60 years, three generations of medical experts in Heʼnan Province have made a series of remarkable scientific research achievements in the molecular mechanism and early detection of esophageal cancer, intervention and prevention methods of precancerous lesions, and benefited thousands of patients. Based on the 34-year research of esophageal cancer prevention and treatment in our research group, this paper focuses on the understanding and thinking about the epidemic characteristics, key scientific issues and important research directions of esophageal cancer in China, so as to provide a reference for the prevention and treatment of esophageal cancer. © 2020, CHINA RESEARCH ON PREVENTION AND TREATMENT. All rights reserved.