Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA.
J Gastrointest Surg. 2013 Aug;17(8):1339-45. doi: 10.1007/s11605-013-2192-7. Epub 2013 Jun 8.
This study seeks to determine the effects of postoperative radiation therapy and lymphadenectomy on survival in esophageal cancer.
An analysis of patients with surgically resected esophageal cancer from the SEER database between 2004 and 2008 was performed to determine association of adjuvant radiation and lymph node dissection on survival. Survival curves were calculated according to the Kaplan-Meier method and log-rank analysis. Multivariate analysis (MVA) was performed by the Cox proportional hazard model.
We identified 2109 patients who met inclusion criteria. Radiation was associated with increased survival in stage III patients (p = 0.005), no benefit in stage II (p = 0.075) and IV (p = 0.913) patients, and decreased survival in stage I patients (p < 0.0001). Univariate analysis revealed that radiation therapy was associated with a survival benefit node positive (N1) patients while it was associated with a detriment in survival for node negative (N0) patients. Removing >12 and >15 lymph nodes was associated with increased survival in N0 patients, while removing >8, >10, >12, >15, and >20 lymph nodes was associated with a survival benefit in N1 patients. MVA revealed that age, gender, tumor and nodal stage, tumor location, and number of lymph nodes removed were prognostic for survival in N0 patients. In N1 patients, MVA showed the age, tumor stage, number of lymph nodes removed, and radiation were prognostic for survival.
The number of lymph nodes removed in esophageal cancer is associated with increased survival. The benefit of adjuvant radiation therapy on survival in esophageal cancer is limited to N1 patients.
本研究旨在探讨术后放疗和淋巴结清扫对食管癌患者生存的影响。
对 2004 年至 2008 年间 SEER 数据库中接受手术治疗的食管癌患者进行分析，以确定辅助放疗和淋巴结清扫与生存的关系。根据 Kaplan-Meier 方法和对数秩检验计算生存曲线。采用 Cox 比例风险模型进行多变量分析（MVA）。
我们共纳入了 2109 例符合条件的患者。放疗与 III 期患者的生存获益相关（p=0.005），与 II 期（p=0.075）和 IV 期（p=0.913）患者的生存获益无关，与 I 期患者的生存降低相关（p<0.0001）。单因素分析显示，放疗与阳性淋巴结（N1）患者的生存获益相关，而与阴性淋巴结（N0）患者的生存降低相关。N0 患者中移除>12 个和>15 个淋巴结与生存获益相关，而 N1 患者中移除>8 个、>10 个、>12 个、>15 个和>20 个淋巴结与生存获益相关。MVA 显示年龄、性别、肿瘤和淋巴结分期、肿瘤位置和淋巴结移除数量与 N0 患者的生存相关。在 N1 患者中，MVA 显示年龄、肿瘤分期、淋巴结移除数量和放疗与生存相关。
食管癌淋巴结移除数量与生存增加相关。辅助放疗对食管癌患者生存的获益仅限于 N1 患者。
