| Objective: The clinical data of 126 patients with cervical lymph node metastasis after radical surgery of esophageal carcinoma were retrospectively analyzed,to observe overall survival,progression-free survival,the short-term effect and toxic reaction of cervical lymph node metastasis after resection of esophageal carcinoma,and to evaluate the effect and prognostic factors.Methods: From January 2008 to December 2014,The data of 126 cases of cervical lymph node metastasis in esophageal carcinoma after radical surgery in Nanchong Central Hospital,General information includes age,sex,tumor site of esophageal carcinoma,the degree of differentiation,T stage,N stage,AJCC2009 stage,tumor lesion length of esophageal carcinoma,adjuvant treatment after esophagectomy,postoperative lymph node metastasis time,lymph node size,dose of radiotherapy,combined chemotherapy,etc.All patients were treated with radical surgery of esophageal carcinoma,postoperative cervical lymph node metastasis were treated with radiotherapy,all radiotherapy were 6mv-x line,3-dimensional conformal radiation therapy(3D-CRT)or Intensity Modulated Radiation Therapy(IMRT),and the prescribed dose of GTV was44~66Gy(median,60Gy),2.0Gy/F.The observation index is the short-term curative effect after the radiotherapy,the toxic reaction,the overall survival(OS),the progression-free survival(PFS)and so on,analyzed each clinical data and the prognosis relation,The database were built by statistical software SPSS17.0,calculate the survival rate by using Kaplan-Meier method,Log-rank test was used to single factor analysis,Cox’s model was used to the multivariate prognostic analysis,the counting data uses the card square test,the setting p<0.05 has the statistical significance.Results: The postoperative lymph node metastasis time was 1-72 monthsin the whole group.Median lymph node metastasis time was 12 months,total radiotherapy efficiency(CR+PR)was 84.9%,the survival rate of 1,2 and 3years were 58.7%,30.2%,18.3%,and median survival time was 16 months;The survival rate was 45.2%,21.4% and 7.1% in the 1,2 and 3 years after radiotherapy,and the median survival time was 12 months.Among them,single factor analysis showed the differentiation degree of esophageal,the short-term effect of cervical lymph node metastasis after radiotherapy,T stage,N stage,clinical staging,dose of radiation,postoperative lymph node metastasis time and prognosis(P<0.05);Low differentiation,middle differentiation,the median survival time and3-year overall survival rate of patients with high differentiation were 23 months,16 months,12 months,24.6%,16.3%,5%(χ2=11.896,P=0.003);Short term efficacy(CR+PR)and ineffective after radiotherapy(SD+ PD)median survival time and 3-year overall survival rate were 20 months,10 months,21.5%,0(χ2=28.819,P=0.000);T1+T2 and T3+T4 patients,the median survival time and 3-year overall survival rate were 22 months,12 months,31.7%,6.1%(χ2=16.322,P=0.000);N0,N1 and N2+N3 patients,the median survival time and3-year overall survival rate after radiotherapy was 23 months,13 months,12 months,24.6%,12.8%,10%(χ2=11.304,P=0.004);Clinical staging was I+IIA period,median survival time and 3-year overall survival rate were 22 months,13 months,31% and 11.9%(χ2=7.192,P=0.007)in patients with IIB+III period;The median survival time and 3-year overall survival rate were 19 months after radiotherapy dose ≥60gy and <60gy radiotherapy,12 months;21.3%,9.4%(χ2=6.314,,P=0.012);Postoperative lymph node time,8 months,≤ 8 months after radiotherapy,median survival time and 3 year overall survival rate were 23 months,12 months,26.3%,4.3%(χ2=21.362,P=0.000).Multi-factor analysis showed that T stage after operation,N stage after operation,radiotherapy dose,After the short-term effect of radiotherapy,postoperative lymphatic metastases time were the independent prognostic factors(P<0.05).In the toxic rection,1-2 levels of radioactive esophagitis were 28 cases(22.2%),There were 1-2 levels of radiation bronchitis in 34 cases(27%),radioactive dermatitis in 10 cases(8.0%),There were 1-2 levels of bone marrow suppression in 22 cases(17.5%),3 levels were 8 case(6.3%),toxicity level<2grade and ≤ 2 grade,1-,2-,3-year overall survival rates were 60.6%,36.1%,20.4%;55.6%,13.9%,8.3%(P > 0.05);The toxicity of radiotherapy and chemotherapy in all patients can be tolerated.Conclusion:For patients with cervical lymph node metastasis after radical surgery of esophageal carcinoma,the prognosis is poor,radiotherapy is an effective treatment method,it can improve the total overall survival rate,T stage,N stage,postoperative cervical lymph node metastasis time,dose of radiotherapy,and the short-term curative effect of radiotherapy is related to the prognosis of patients.That is,postoperative T1 and T2,Postoperative N0 period,postoperative cervical lymph node metastasis time > 8 months,dose of radiotherapy≥ 60 gy,the short-term curative effect after radiotherapy has the better prognosis. |
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