食管癌术前放疗后病理反应与预后的关系

目的　探讨食管癌术前放疗后病理反应与远期生存之间的关系 ,以及放射敏感性在食管癌放疗中的意义。方法　 176例食管癌术前放疗后行肿瘤切除的患者 ,按放疗后肿瘤组织的病理反应分为轻、中、重度反应组 ,分析各组间的总生存率、无病生存率及相关的影响因素 ,并与 191例单纯手术患者进行对照。结果　 (1)重、中、轻度反应组的 5年总生存率分别为 6 0 .7%、4 6 .4 %和2 1.1% ,重度反应组优于中度反应组 (P =0 .0 2 9) ,中度反应组优于轻度反应组 (P =0 .0 13)。与单纯手术组的 5年生存率 (38.8% )比较 ,重度反应组优于单纯手术组 (P =0 .0 0 0 ) ,中度反应组稍优于单纯手术组 (P =0 .2 95 ) ,轻度反应组低于单纯手术组 (P =0 .0 34)。 (2 )重、中、轻度反应组 5年无病生存率分别为 5 5 .7%、4 0 .7%和 18.7% ,重度反应组优于中度反应组 (P =0 .0 2 9) ,中度反应组优于轻度反应组(P =0 .0 18)。与单纯手术组的 5年无病生存率 (33.3% )比较 ,重度反应组优于单纯手术组 (P =0 .0 0 0 ) ,中度反应组稍优于单纯手术组 (P =0 .2 3) ,轻度反应组低于单纯手术组 (P =0 .0 96 )。 (3)重度反应组T4、N1、Ⅰ～Ⅱ期和根治切除的比例分别为 9.8%、18.0 %、90 .2 %和 90 .2 % ,中度反应组分别为 2 0 .3%、15 .9%、79.7%

Relation between pathologic tumor response to preoperative radiotherapy and the prognosis in patients with esophageal carcinoma

OBJECTIVE: To analyze the relation between pathologic tumor response in preoperative radiotherapy and long-term survival in patients with esophageal carcinoma and the significance of radiosensitivity in the treatment of esophageal carcinoma. METHODS: 176 esophageal cancer patients received preoperative radiotherapy and tumor resection from 1977 to 1989. The radio-response was classified into severe, moderate and mild according to the tumor pathologic response to radiotherapy. 191 patients treated by surgery alone served as control. The relation between radiation response of tumor and long-term survival and disease free survival was analyzed. RESULTS: The 5-year survival rates of severe, moderate, mild and control groups were 60.7%, 46.4%, 21.1% and 38.8%. The survival was significantly improved in severe than moderate one (P = 0.029), moderate than mild group (P = 0.013) and severe than the control group (P = 0.000). It was only slightly improved in the moderate than control group (P = 0.295), but decreased in mild than the control group (P = 0.034). The 5-year disease-free survival (DFS) rates were 55.7%, 40.7%, 18.7% and 33.3% in severe, moderate, mild and control groups. The DFS was significantly improved in severe than moderate group (P = 0.029), moderate than mild group (P = 0.018), severe than the control group (P = 0.000 4). It was only slightly improved in moderate than the control group (P = 0.23), but decreased in the mild than the control group (P = 0.096). In the severe group, the proportion of stage T4, N1 lesion, TNM stage I-II and number of radical resection were 9.8%, 18%, 90.2%, and 90.2%. In the moderate group, they were 20.3%, 15.9%, 79.7% and 82.6%. In the mild group, they were 42.2%, 37.8%, 53.3% and 46.7%. In the control group, they were 50.3%, 40.8%, 37.7% and 77.5%. The rates of downstaging and surgical resection were improved only in severe and moderate groups (P < 0.01). CONCLUSION: The fact that only patients in whom severe radiation response are observed would appreciably benefit from preoperative radiotherapy whereas the others do not, illustrates that there might be no benefit of radiotherapy for radioresistant esophageal carcinoma. Radiosensitivity measurement before preoperative radiotherapy would be valuable for individualized treatment.