三维适形放疗与手术治疗可手术食管癌患者110例远期生存分析

摘要

目的:探讨三维适形放疗与手术治疗可手术食管癌的临床疗效及远期生存情况.方法:选择本院2000年6月～2006年6月收治的可手术食管癌患者110例,其中50例患者给予全程三维适形放疗,50～70 Gy 5～7周完成(放疗组),同期60例患者给予单纯手术治疗(手术组).统计分析两组治疗效果及远期生存情况,并对患者预后影响因素进行分析.结果:放疗组50例患者均完成全程放疗,28例(56.0%)完全缓解,22例部分缓解(44.0%),有效率为100%.60例手术患者均顺利完成手术,术中未出现严重并发症及意外死亡.全部患者完成随防,两组1年、3年生存率(84.0% vs 83.3%,52.0% vs 56.7%)比较,差异无统计学意义(x2=1.16,1.59,P>0.05),5年生存率比较,手术组(41.7%)高于放疗组(30.0%),差异有统计学意义(x2=7.69,P<0.05).至随访结束,放疗组患者死亡35例,其中16例死于局部复发,8例死于远处转移,同时合并复发和转移者4例,其他原因5例.手术组患者死亡35例,10例死于术后并发症,18例死于老年合并症,3例死于癌转移,4例死于其他原因.放疗患者单因素分析显示,患者年龄、病变部位、病变长度、侵袭深度、近期疗效是影响患者预后的主要因素,多因素回归分析显示患者年龄、病变部位及长度是影响患者预后的独立因素.结论:三维适形放疗治疗可手术食管癌患者疗效较好,可以作为手术治疗外的一种较好选择.%Objective: To investigate the clinical efficacy and long-term survival of operable esophageal cancertreated with three-dimensional conformal radiotherapy (3DCRT) and surgical treatment. Methods: 110 patients with operable esophageal cancer in our hospital from June 2000 to June 2006 were divided into radiotherapy group(50 cases given 3DCRT completed in 5-7 weeks with dose of 50-70 Gy) and surgery group (60 cases with surgery treatment). Treatment effect and long-term survival of two groups and prognostic factors were analyzed. Results: 50 patients in radiotherapy group all completed the whole radiotherapy, 28 patients (56.0%) were complete remission, 22 were partial response (44.0%), the effective rate was 100%. 60 cases of surgical patients were successfully operated, no serious intra operative complications and accidental death. All patients got follow-up, the differences of 1-,3-year survival rates (84.0% vs 83.3%,52.0% vs 56.7%) were not statistically significant(χ2=1.16, 1.59, P>0.05), 5-year survival rate of surgery group (41.7%) was higher than radiotherapy group(30.0%), the difference was statistically significant(χ2=7.69, P<0.05). 35 patients died in radiotherapy group, of which 16 patients died of local recurrence, 8 patients died of distant metastasis, and combined recurrence and metastasis in 4 cases, other causes in 5 cases. 35 cases died in surgery group, of which 10 patients died of postoperative complications, 18 patients died of old age complications, 3 patients died of metastases, and other causes in 4 patients. Univariate analysis of ra -diotherapy group showed that patient age, lesion position, lesion length, depth of invasion, short-term effect were the main factor affecting the prognosis of patients, and the age, length and position of lesion were independent prognostic factors in multivariate analysis. Conclusion: The effect of 3DCRT in patients with operable esophageal cancer is better, and it can be used as a better choice except surgical treatment.