目的:分析伴锁骨上淋巴结转移食管癌患者的放射治疗的疗效及其预后影响因素,进一步评价食管癌临床分期.方法:回顾性分析资料完整的68例接受三维适形放疗的初治食管癌伴锁骨上淋巴结转移的患者,对预后生存进行单因素和多因素分析,锁骨上淋巴结转移与食管癌临床分期的关系及其对预后的影响.结果:全组患者原发灶治疗后完全缓解(CR)26例,部分缓解(PR)33例,无变化(NR)9例.全组锁骨上转移淋巴结治疗后CR 49例,PR 19例,总有效率为100%.全组1、2、3年生存率分别为51.4%、31.0%和15.0%,中位生存期15.0个月.单因素分析表明病变部位、病变长度、原发灶放疗剂量、腹腔淋巴结转移、锁骨上转移淋巴结的大小及化疗为影响预后的因素.其中病变部位、原发灶放疗剂量、锁骨上转移淋巴结的大小及化疗为独立预后影响因素.食管胸下段癌患者的生存率及中位生存期均最低.结论:放化疗联合者可作为中晚期食管癌的主要治疗方法,胸上段食管癌伴锁骨上淋巴结转移者应归为区域淋巴结转移.%Objective: To study the prognostic factors for patients with esophageal carcinoma with supraclavicular lymph node metastasis after 3-dimensional conformal radiotherapy ( 3D-CRT ) and to evaluate the validity of the clinical staging. Methods: A total of 68 esophageal carcinoma patients with supraclavicular lymph node metastasis treated by 3D-CRT were reviewed and the possible prognostic factors were analyzed. The relationship between supraclavicular lymph node metastasis of esophageal cancer and clinical staging was investigated. Results: After radiotherapy for primary cancer, 26 patients had tumor complete regression ( CR ), 33 patients had partial regression ( PR ), 9 patients had no response ( NR ). After treatment for supraclavicular lymph node metastasis, 49 patients had CR and 19 patients had PR. The 1 -, 2- and 3-year survival rates were 51.4 ％, 34.0 ％, and 15.0 ％, respectively. The median survival time was 15 months. Univariate analysis showed that the lesion location, the length of tumor, the radiation dose for the primal cancer, celiac lymph node metastasis, the size of supraclavicular lymph node and chemotherapy were prognositic factors. Multivariate analysis showed that the lesion location, the radiation dose for the primarily cancer, the size of supraclavicular lymph node and chemotherapy were independent prognostic factors. Patients with inferior esophageal carcinoma had lower survival rate and shorter median survival time. Conclusion: Radiotherapy combined with chemotherapy is the major treatment for advanced esophageal carcinoma. For superior esophageal carcinoma, the supraclavicular lymph node metastasis is regional lymph node metastasis.
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