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目的:探讨食管鳞癌根治术后上纵隔1与2区淋巴结转移患者放射治疗的疗效及预后影响因素。方法:回顾性分析2008-09-22-2012-04-19南京大学医学院附属鼓楼医院收治的36例食管鳞癌根治术后上纵隔1与2区淋巴结转移患者的临床资料,36例患者均接受了三维适形或调强适形放疗,联合化疗27例。生存分析和多因素分析分别采用Kaplan-Meier法和Cox比例风险模型。结果:36例患者放疗结束后总有效率(CR+PR)为77.8%(28/36),其中CR 22.2%(8/36),PR 55.6%(20/36),SD 22.2%(8/36),PD 0(0/36);中位生存期为13个月,6个月、1和2年生存率分别为70.4%、52.5%和26.0%。单因素分析显示,术后分期(P=0.015)、转移淋巴结最大径(P=0.017)、放疗剂量(P=0.027)及放疗后是否达CR(P=0.026)对于食管鳞癌术后上纵隔1与2区转移淋巴结放疗疗效有显著影响。Cox多因素分析表明,术后分期(P=0.006)和放疗剂量(P=0.010)为独立的预后影响因子。结论:食管鳞癌根治术后发生上纵隔1与2区淋巴结转移者,可采用三维适形或调强适形放疗作为补救治疗方案,术后临床分期较早或高剂量放疗组放射治疗后的预后分别优于术后分期晚及低剂量放疗组。
Objective: To investigate the efficacy and prognostic factors of radiotherapy in patients with lymph node metastasis of upper mediastinum after radical mastectomy of esophageal squamous cell carcinoma. Methods: Retrospective analysis of the clinical data of 36 cases of esophageal squamous cell carcinoma radical mastectomy in patients with lymph node metastasis of grade 1 and 2 admitted to Drum Tower Hospital, Nanjing University Medical College, 2008-09-22-2012-04-19, 36 patients Received three-dimensional conformal or intensity-modulated conformal radiotherapy, combined chemotherapy in 27 cases. Survival analysis and multivariate analysis were used Kaplan-Meier method and Cox proportional hazards model. Results: The total effective rate (CR + PR) of the 36 patients after radiotherapy was 77.8% (28/36), of which CR 22.2% (8/36), PR 55.6% (20/36), SD 22.2% 36) and PD 0 (0/36). The median survival time was 13 months. The 6-month, 1-year and 2-year survival rates were 70.4%, 52.5% and 26.0%, respectively. Univariate analysis showed that postoperative staging (P = 0.015), maximum diameter of metastatic lymph nodes (P = 0.017), radiotherapy dose (P = 0.027) and CR after radiotherapy (P = 0.026) 1 and 2 lymph node metastasis of radiation therapy have a significant effect. Cox multivariate analysis showed that postoperative staging (P = 0.006) and radiotherapy dose (P = 0.010) were independent prognostic factors. CONCLUSIONS: Patients with esophageal squamous cell carcinoma of the mediastinum in the first and second lymph node metastasis after radical resection, can be three-dimensional conformal or intensity-modulated conformal radiotherapy as a remedial treatment, postoperative clinical stage earlier or high-dose radiotherapy group after radiotherapy Prognosis were better than postoperative staging and low dose radiotherapy group.