95例伴气管食管沟淋巴结转移食管癌三维放疗±化疗疗效分析

目的 探讨食管癌气管食管沟淋巴结(TGLN)转移患者3DCRT±化疗疗效。方法 对2003—2010年间符合入组条件的95例有TGLN转移的食管癌患者治疗情况进行回顾分析,分析疗效、预后影响因素及治疗失败模式等。 95例放疗 54~68 Gy分27~34次5~7周完成, 38例加“顺铂”为基础方案化疗,其中同期放化疗14例、序贯放化疗24例。Kaplan Meier 法计算生存率, Cox 模型多因素预后分析。结果 随访率100%。治疗结束后患者食管病变总有效率为94%;转移淋巴结病变治疗后有效率为100%。1、2、 3年OS分别为53%、32%、24%,中位生存时间13个月。多因素分析结果显示患者治疗前有无胸背部疼痛(P=0.041)、病变造影长度(P=0.002)及食管病变近期疗效(P=0.000)为预后影响因素。全组患者出现单纯食管复发18例,单纯淋巴结转移或复发 4例,食管复发伴淋巴结转移或复发 5例,单纯远处转移 28例,食管复发伴远处转移4例,远处转移伴淋巴结转移或复发3例,食管复发合并淋巴结转移或复发并伴远处转移 2例。结论 食管癌伴TGLN转移患者接受3DCRT ±化疗较为安全,但疗效有待进一步提高。影响食管癌伴TGLN转移患者的主要预后因素与食管病变相关。

Efficacy of three-dimensional radiotherapy ± chemotherapy in 95 esophageal cancer patients with tracheoesophageal groove lymph node metastasis

Objective To investigate the efficacy of three-dimensional conformal radiotherapy (3DCRT)±chemotherapy in esophageal cancer patients with tracheoesophageal groove lymph node (TGLN) metastasis. Methods A retrospective analysis was performed on 95 eligible esophageal cancer patients with TGLN metastasis from 2003 to 2010 to investigate the treatment outcome, prognostic factors, failure mode, etc. All patients received radiotherapy at 54-68 Gy/27-34 fractions within 5-7 weeks, and 38 of them also received cisplatin-based chemotherapy (concurrent chemoradiotherapy in 14 patients and 24 in sequential chemoradiotherapy). The Kaplan-Meier method was used to calculate survival rates, and the Cox regression model was used for multivariate prognostic analysis. Results The follow-up rate was 100%. After treatment, the overall response rate was 94% for esophageal lesions and 100% for metastatic lymph node lesions. The 1-, 2-, and 3-year overall survival rates were 52.5%, 31.6%, and 23.8%, respectively, and the median survival time was 13 months. Multivariate analysis showed that presence or absence of back/chest pain before treatment (P=0.041), the length of lesion (P=0.002), and the short-term outcome of esophageal lesion (P=0.000) were independent prognostic factors. In all patients, 18 had simple esophageal recurrence, 4 had simple lymph node metastasis or recurrence, 5 had esophageal recurrence with lymph node metastasis/recurrence, 28 had simple distant metastasis, 4 had esophageal recurrence with distant metastasis, 3 had distant metastasis with lymph node metastasis/recurrence, and 2had esophageal recurrence with lymph node metastasis/recurrence with distant metastasis. Conclusions 3DCRT±chemotherapy is safe for esophageal cancer patients with TGLN metastasis, but its efficacy needs to be further improved. The independent prognostic factors mostly correlate with esophageal lesion for these patients.