Clinical study of modified Ivor-Lewis esophagectomy plus adjuvant radiotherapy for local control of stage IIA squamous cell carcinoma in the mid-thoracic esophagus
Clinical study of modified Ivor-Lewis esophagectomy plus adjuvant radiotherapy for local control of stage IIA squamous cell carcinoma in the mid-thoracic esophagus
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DOI：
10.1016/j.ejcts.2008.09.002
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发表时间：
2009-01-01
影响因子：
3.4
通讯作者：
Liu, Fan-ying
中科院分区：
文献类型：
--
作者：
Chen, Gang;Wang, Zhou;Liu, Fan-ying
目的：控制食管癌术后局部复发是改善患者预后的关键因素之一。本研究的目的是评价改良Ivor-Lewis食管切除术加辅助放疗局部控制胸中段食管IIA期鳞状细胞癌的有效性。研究方法：1999年6月至2002年6月期间，125例IIA期胸中段食管鳞状细胞癌患者接受了改良Ivor-Lewis食管切除术，纳入回顾性分析。所有患者在术后3年内进行评估，以检测肿瘤复发。Kaplan-Meier法计算生存率，Logistic回归分析局部复发的危险因素。结果：本组患者3年和5年生存率分别为58.4%和43.2%。术后3年内复发61例（48.8%）。中位无病期为12.6个月。局部复发33例（26.4%），远处复发23例（18.4%），局部和远处同时复发5例（4.0%）。术后放疗组局部复发率明显低于未放疗组（P < 0.05）。Logistic回归分析显示，辅助放疗（p = 0.007）是肿瘤局部复发的独立危险因素。考克斯回归分析显示，局部复发是IIA期食管癌患者的相关预后因素，而辅助放疗不是。结论：改良Ivor-Lewis食管切除术联合双视野淋巴结清扫加辅助放疗可能是实现胸中段食管鳞状细胞癌局部控制的有效策略。（D 2008欧洲胸外科协会。Elsevier B. V.出版，保留所有权利。
Objective: To control the postoperative local recurrence is one of the critical factors to improve prognosis of patients with esophageal carcinoma. The aim of this study is to evaluate the effectiveness of modified Ivor-Lewis esophagectomy plus adjuvant radiotherapy for local control of stage IIA squamous cell carcinoma in the mid-thoracic esophagus. Methods: One hundred and twenty-five patients with stage IIA mid-thoracic esophageal squamous cell carcinoma who underwent modified Ivor-Lewis esophagectomy between June 1999 and June 2002 were included in the retrospective analysis. All the patients were evaluated within 3 years after surgery to detect tumor recurrence. Kaplan-Meier method was used to calculate the survival rate and logistic regression analysis was performed to identify risk factors of locoregional recurrence. Results: The overall 3-year and 5-year survival rate in at( patients was 58.4% and 43.2%, respectively. Tumor recurrence occurred in 61 patients (48.8%) within 3 years after operation. The median disease-free interval was 12.6 months. Thirty-three patients (26.4%) developed locoregional recurrence, 23 patients (18.4%) developed distant recurrence and 5 patients (4.0%) developed locoregional and distant recurrence simultaneously. Locoregional recurrence rate of patients with postoperative radiotherapy was significantly lower than that of those without postoperative radiotherapy (p < 0.05). Logistic regression analysis showed that adjuvant radiotherapy (p = 0.007) was an independent risk factor for tumor locoregional recurrence. Cox regression analysis showed that locoregional recurrence but not adjuvant radiotherapy was a relevant prognostic factor of patients with stage IIA esophageal cancer. Conclusions: Modified Ivor-Lewis esophagectomy with two-field lymph node dissection plus adjuvant radiotherapy might be an effective strategy to achieve local control of stage]]A mid-thoracic esophageal squamous cell carcinoma. (D 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.