新辅助放化疗对中晚期食管癌切除率和预后的影响

目的:探讨新辅助放化疗对中晚期食管癌切除率和预后的影响。方法:志愿接受本治疗研究的中晚期食管癌病人474例,随机分为A(研究组)、B(对照组)两组,每组237例。A组术前118例接受放疗40Cyx4Ws,119例接受FMP方案化疗1疗程。放化疗结束后2～4周手术,比较两组临床病理分期、手术切除率、并发症和术后生存的情况。结果:各组间手术并发症和死亡率相当。A组中放疗组根治切除率为99.15％,高于化疗组和B组,放疗肿瘤明显缩小率73.73％,高于化疗组。pT-NM分期:Ⅱa期比例26.58％、Ⅱb期11.79％、Ⅲ期58.23％;B组切除率为75.53％,Ⅱa期比例0、Ⅱb期5.59%、Ⅲ期89.94％;术后4年生存率A组中放疗组高于化疗组和B组,化疗组与B组间差异无显著性意义。结论:新辅助放疗优于化疗,能显著降低pTNM分期,提高手术切除率,提高病人术后4年生存率,并不增加手术并发症和死亡率。

Effection of Neo-adjuvant Chemo-and Radio-therapies on the Tumor Resection Rate and the Survival Rate of Patients with Esophageal Carcinomas in Medi and Late Stages

Objective:To observe the effection of neo-adjuvant chemo and radio-therapies on the tumor resection rate and the postoperative survival rate of patients with esophageal carcinomas in medi and late stages. Methods:474 case of esophageal carcinomas in medi and late stages were enrolled in the study. 118 patients who entered volunterly as group A (trial group) received 40Gy x4 weeks preoperative radiotherapy or one courses of FMP chemotherapy. Esophagectomy were performed two to four weeks late as the group B ( control group). Then we compared the resection rate, death rate and complications related to the operations, and the postoperative survival rate of the patients, etc. Results:The tumor resection rate of group A was 100% , pTNM stages: II a 26. 58% , II b 11. 79% , III 58. 23% ; whereas that of group B were 75. 53% , II a 0, II b 5. 59% , III 89. 94% accordingly. No significant differences were showed in the complications between the two groups, but the postoperative four years survival rate of radiotherapy subgroup was notably higher than that of other groups. Conclusion:The strategy of neo-adjuvant radiotherapy was superior to neo-adjuvant chemotherapy in treatment of patients with esophageal carcinomas in medi and late stages, for it hold down the pTNM stages, uprised the tumor resection rate and probably plus the postoperative four year survival rate. Nevertheless, the complications and death rates were not raised.