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目的探讨胸段食管鳞癌R0切除术后p T3~4N0或p T1~4N1~3患者接受辅助治疗的临床疗效。方法回顾性分析2009年1月至2013年12月间收治的胸段食管鳞癌R0切除术后p T3~4N0或p T1~4N1~3患者接受术后辅助治疗的情况,共入组患者262例,根据术后辅助治疗情况分为单纯手术组(n=111)、辅助化疗组(n=91)和辅助放疗组(n=60)。采用Kaplan-Meier法计算生存率,Cox多因素回归法分析影响患者预后的独立因素。结果辅助放疗组和辅助化疗组患者的中位无病生存期(DFS)均优于单纯手术组(均P<0.05),但辅助放疗组与辅助化疗组间差异无统计学意义(P=0.664)。辅助放疗组和辅助化疗组患者的中位总生存期(OS)均优于单纯手术,差异均有统计学意义(均P<0.05),但辅助放疗组和辅助化疗组间差异无统计学意义(P=0.944)。对于p T3~4N0患者,辅助化疗组OS高于单纯手术组(P=0.042);对于p T1~4N1~3患者,辅助放疗组及辅助化疗组OS均优于单纯手术组(均P<0.05),但辅助放疗组与辅助化疗组差异无统计学意义(P=0.310)。而对于局部浸润较深且淋巴结转移的p T3~4N0患者,辅助放疗组和辅助化疗组OS均优于单纯手术组(均P<0.05),且辅助放疗组也优于辅助化疗组(P=0.011)。Cox多因素回归分析显示,肿瘤部位、肿瘤浸润深度(p T)、病理淋巴结转移个数(p N)、肿瘤分析程度、术后治疗均为影响患者生存的独立预后因素(均P<0.05)。结论对于p T1~4N1~3患者,术后辅助化疗或辅助放疗均可显著改善DFS和OS,其中p T3~4N1~3患者,辅助放疗获益更大。
Objective To investigate the clinical efficacy of adjuvant therapy for patients with p T3 ~ 4N0 or p T1 ~ 4N1 ~ 3 after thoraco-esophageal squamous cell carcinoma R0 resection. Methods The postoperative adjuvant treatment of patients with p T3 ~ 4N0 or p T1 ~ 4N1 ~ 3 after R0 resection of thoracic esophageal squamous cell carcinoma was retrospectively analyzed from January 2009 to December 2013. A total of 262 patients Cases, according to postoperative adjuvant treatment were divided into simple surgery group (n = 111), adjuvant chemotherapy group (n = 91) and adjuvant radiotherapy group (n = 60). Kaplan-Meier method was used to calculate the survival rate, and Cox regression analysis was used to analyze the independent factors influencing the prognosis of patients. Results The median disease-free survival (DFS) of the adjuvant radiotherapy and adjuvant chemotherapy groups were superior to that of the surgery alone group (all P <0.05), but there was no significant difference between the adjuvant radiotherapy group and the adjuvant chemotherapy group (P = 0.664 ). The median overall survival (OS) of patients in adjuvant radiotherapy and adjuvant chemotherapy groups was better than that of surgery alone (all P <0.05), but there was no significant difference between adjuvant radiotherapy and adjuvant chemotherapy (P = 0.944). For patients with p T3 ~ 4N0, the OS of the adjuvant chemotherapy group was higher than that of the surgery alone group (P = 0.042). The OS of the adjuvant radiotherapy group and the adjuvant chemotherapy group was superior to that of the surgery alone group (all P <0.05 for pT1 ~ 4N1 ~ 3) ), But there was no significant difference between adjuvant radiotherapy and adjuvant chemotherapy (P = 0.310). For p T3 ~ 4N0 patients with deep partial invasion and lymph node metastasis, both the adjuvant radiotherapy group and the adjuvant chemotherapy group were superior to the surgery alone group (all P <0.05), and the adjuvant radiotherapy group was superior to the adjuvant chemotherapy group (P = 0.011). Cox multivariate regression analysis showed that the location of the tumor, the depth of tumor invasion (p T), the number of pathological lymph node metastases (p N), the degree of tumor analysis and the postoperative treatment were all independent prognostic factors influencing the survival of patients (all P <0.05) . Conclusions Postoperative adjuvant chemotherapy or adjuvant radiotherapy can significantly improve DFS and OS in patients with pT1 ~ 4N1 ~ 3, and patients with pT3 ~ 4N1 ~ 3 may benefit from adjuvant radiotherapy.