- 作者：Junqiang Chen ; M.D.&lowast ; ; Jianji Pan ; M.D.&lowast ; ; panjianji@126.com ; Xiongwei Zheng ; M.D.&dagger ; ; Kunshou Zhu ; M.D.&Dagger ; ; Jiancheng Li ; M.D.&lowast ; ; Mingqiang Chen ; M.D.&lowast ; ; Jiezhong Wang ; M.D.&lowast ; ; Zhongxing Liao ; M.D.¶ ;
- 关键词：Esophageal squamous cell carcinoma ; Three-field lymphadenectomy ; Lymph node metastasis ; Nodal basins ; Adjuvant radiotherapy
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2012
- 出版时间：1 January 2012
- 年：2012
- 卷：82
- 期：1
- 页码：475-482
- 全文大小：505 K
Purpose
To analyze influences of the number and location of positive lymph nodes and postoperative radiotherapy on survival for patients with thoracic esophageal squamous cell carcinoma (TE-SCC) treated with radical esophagectomy with three-field lymphadenectomy.Methods and Materials
A total of 945 patients underwent radical esophagectomy plus three-field lymph node dissection for node-positive TE-SCC at Fujian Provincial Tumor Hospital between January 1993 and March 2007. Five hundred ninety patients received surgery only (S group), and 355 patients received surgery, followed 3 to 4 weeks later by postoperative radiotherapy (S+R group) to a median total dose of 50 Gy in 25 fractions. We assessed potential associations among patient-, tumor-, and treatment-related factors and overall survival.
Results
Five-year overall survival rates were 32.8 % for the entire group, 29.6 % for the S group, and 38.0 % for the S+R group (p = 0.001 for S vs. S+R). Treatment with postoperative radiotherapy was particularly beneficial for patients with ? positive nodes and for those with metastasis in the upper (supraclavicular and upper mediastinal) region or both the upper and lower (mediastinal and abdominal) regions (p < 0.05). Postoperative radiotherapy was also associated with lower recurrence rates in the supraclavicular and upper and middle mediastinal regions (p < 0.05). Sex, primary tumor length, number of positive nodes, pathological T category, and postoperative radiotherapy were all independent predictors of survival.
Conclusions
Postoperative radiotherapy was associated with better survival for patients with node-positive TE-SCC, particularly those with three or more positive nodes and positive nodes in the supraclavicular and superior mediastinal regions.