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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。
Objective To investigate the effect of preoperative radiotherapy on the survival of patients with stage Ⅱ esophageal squamous cell carcinoma. Methods A total of 381 cases of stage Ⅱ esophageal squamous cell carcinoma patients were all from the information database of 500,000 cases of esophageal and cardiac cancer biological samples from 1973 to 2014 in Key Laboratory of Esophageal Cancer of the First Affiliated Hospital of Zhengzhou University. All patients were confirmed histopathologically as stage II esophageal squamous cell carcinoma and were randomly divided into preoperative radiotherapy group [male 75, average age 58.83 ± 8.67; female 52, mean age 60.46 ± 9.24) and surgery alone group (145 males, mean age at diagnosis of (59.23 ± 7.94) years; female 109, mean age at diagnosis of (60.29 ± 9.02) years]. Preoperative radiotherapy group with 6MV-X-ray irradiation in vitro, the dose of 40 ~ 60 Gy / 4 ~ 6 weeks, 2 to 4 weeks after surgery for surgery. Survival analysis using Kaplan-Meier method between the two groups compared Log-rank test and compared the survival rate of 1, 3, 5, postoperative complications, local lymph node metastasis and the posterior terminal residual cancer positive rate. Results Kaplan-Meier and Log-rank test showed that the 1, 3, 5-year survival rates of preoperative radiotherapy group were 87%, 67%, 59% and 84%, 70% and 57% = 0.964). The postoperative complications of the two groups were 17.32% and 13.39%, respectively. The rates of local lymph node metastasis were 14.17% and 16.93%, respectively. The positive rates of residual cancer were 0.78% and 3.54%, respectively, with no significant difference (P> 0.05 ). Conclusion Compared with simple surgical treatment, preoperative radiotherapy has no significant effect on the survival of patients with stage Ⅱ esophageal squamous cell carcinoma.