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目的探讨术前放化疗合并腔镜手术近期疗效敏感的食管癌患者不同预后结局的原因。方法选取浙江省台州医院2011年6月—2014年6月术前放化疗合并腔镜手术治疗的符合纳入条件的中晚期食管癌患者21例。本组患者治疗前分期为ⅡB~ⅢA期,术前化疗采取NP方案静脉注射(长春瑞滨针25 mg/m~2,d_(1、8、22、29)及顺铂针25 mg/m~2,d_(1~4、22~25)),同期采用40 Gy/20 F常规分割放疗。放化疗后约7周施行胸腹腔镜联合下食管癌根治术。21例患者均为近期疗效敏感:原发灶病理缓解、腔镜手术实施顺利、术后无重大并发症发生并随访资料完整的病例。将年龄、性别、肿瘤位置、肿瘤长度、治疗前临床分期、术前放化疗方案完成情况、术前放化疗至手术时间、手术持续时间、术中出血量、清扫淋巴结区域及数目、阳性淋巴结病理情况、术后住院时间等相关因素进行多因素分析。结果 21例随访时间16~60个月,平均(44.6±12.6)个月,3、5年总的生存率分别为85.21%、73.85%。多因素分析结果表明年龄、术后病理淋巴结阳性是影响本组患者不同预后的独立因素(P<0.05)。结论术前放化疗并腔镜手术治疗局部中晚期食管癌是一种有效的治疗模式,尤其是对于近期疗效敏感的患者总体预后较好,但因为肿瘤异质性和个体差异性,加之年龄、淋巴结转移等众多因素可能造成预后结局不同。
Objective To investigate the causes of different outcomes of patients with esophageal cancer who are sensitive to the short-term curative effect of preoperative chemoradiotherapy and endoscopic surgery. Methods Twenty-one patients with advanced esophageal cancer were enrolled in our hospital from June 2011 to June 2014 in Taizhou Hospital of Zhejiang Province. The patients before treatment staging for Ⅱ B ~ Ⅲ A period, preoperative chemotherapy to NP program intravenous injection (vinorelbine needle 25 mg / m ~ 2, d_ (1,8,22,29) and cisplatin needle 25 mg / m ~ 2, d_ (1 ~ 4, 22 ~ 25)), the same period using 40 Gy / 20 F conventional radiotherapy. About 7 weeks after radiotherapy and chemotherapy, thoracotomy combined with laparoscopic radical mastectomy for esophageal cancer. All of the 21 patients were sensitive to the short-term curative effect: the pathology of the primary lesion was relieved, and the laparoscopic operation was well performed. No major complication occurred after the operation and the complete cases were followed up. The age, sex, tumor location, tumor length, pre-treatment clinical stage, preoperative radiotherapy and chemotherapy regimen completed, preoperative radiotherapy and chemotherapy to surgery time, operation duration, intraoperative blood loss, lymph node dissection and the number of positive lymph node pathology Conditions, postoperative hospital stay and other related factors for multivariate analysis. Results 21 cases were followed up for 16-60 months with an average of (44.6 ± 12.6) months. The overall survival rates at 3 and 5 years were 85.21% and 73.85% respectively. Multivariate analysis showed that age and postoperative pathological lymph node positive were independent prognostic factors of this group (P <0.05). Conclusions Preoperative chemoradiotherapy and endoscopic surgery for locally advanced esophageal cancer is an effective treatment model, especially for those patients who are sensitive to the recent curative effect. However, due to heterogeneity of the tumor and individual differences, together with the differences of age, Many factors such as lymph node metastasis may result in different prognosis outcomes.