术前放疗对Ⅱ期食管鳞癌患者的生存影响

摘要

Objective To evaluate the impact of preoperative radiotherapy on the survival of the esophageal cancer patients with stage Ⅱ.Methods A total of 381 esophageal cancer patients with stage Ⅱ were enrolled in this study.All the clinical information was derived from the databases of 500 000 esophageal and gastric cardiac carcinomas (1973-2014) of the Henan Key Laboratory for Esophageal Cancer Research.Histopathologically, all the patients were confirmed as stage Ⅱ.These patients were divided randomly into 2 groups: preoperative radiotherapy group with a total of 127 cases [75 males with an average diagnosed age of (58.83±8.67) years and 52 females with an average diagnosed age of (60.46±9.24) years]and surgery alone group with a total of 254 cases [145 males with an average diagnosed age of (59.23±7.94) years and 109 females with an average diagnosed age of (60.29±9.02) years].The conventional external irradiation with 6MV Linear Accelerator was applied to the preoperative radiotherapy group with a total of 40~60 Gy/4~6 weeks.The surgical treatment was followed after 2~4 weeks radiotherapy. The SPSS 21.0 statistical software was applied for all the data analysis. The survival rate was calculated based on Kaplan-Meier and Log-rank analysis model. The further analysis was performed between the two groups for the postoperative complications, the local lymph node metastasis and the positive stump of the residual cancer. Results The Kaplan-Meier and Log-rank analysis showed that the 1-, 3-and 5-year overall survival rates were 87%, 67% and 59% in preoperative radiotherapy group, and 84%, 70% and 57% in surgery alone group, respectively. There was no significant difference for the two groups (P=0.964). Moreover, a similar prevalence was observed between the two groups for the postoperative complications (17.32% vs 13.39%), the local lymph node metastasis (14.17% vs 16.93%) and the stump positive rate of residual cancer (0.78% vs 3.54%) (P>0.05).Conclusion The present study demonstrates that, comparing with surgery alone, the preoperative radiotherapy does not show any improvement in overall survival on the esophageal cancer patients with stage Ⅱ.%目的 探讨术前放疗对Ⅱ期食管鳞癌患者的生存影响.方法 381例Ⅱ期食管鳞癌患者全部来自郑州大学第一附属医院河南省食管癌重点开放实验室1973-2014年间50万食管癌与贲门癌生物样品信息数据库.所有患者均经组织病理学确诊为Ⅱ期食管鳞癌,并随机分为术前放疗组[男75例,平均诊断年龄为(58.83±8.67)岁;女52例,平均诊断年龄为(60.46±9.24)岁]和单纯手术组[男145例,平均诊断年龄为(59.23±7.94)岁;女109例,平均诊断年龄为(60.29±9.02)岁].术前放疗组采用6MV-X射线体外照射,剂量为40~60 Gy/4~6周,休息2~4周后进行手术.生存分析采用Kaplan-Meier法,组间比较Log-rank检验并对比两组1、3、5年生存率,术后并发症、局部淋巴结转移及断端残癌阳性率.结果 Kaplan-Meier和Log-rank检验显示:术前放疗组与单纯手术组1、3、5年生存率相似,分别为87%,67%,59%和84%,70%,57%(P=0.964).两组术后并发症分别为17.32%和13.39%,局部淋巴结转移率分别为14.17%和16.93%,断端残癌阳性率分别为0.78%和3.54%,差异均无统计学意义(P>0.05).结论 与单纯手术治疗相比,术前放疗对Ⅱ期食管鳞癌患者生存无明显影响.