| Objective: To analyze the influence of prophylactic radiotherapy after radical resection for local regional recurrence rate, local control rate, metastasis rate and survival rate. To investigate the significance of prognosis in the metastatic lymph node number, lymph node metastasis region and postoperative pathological tumor volume grade.Methods: 355 patients who underwent redical esophagectomy at the Fourth Hospital of Hebei Medical University from June 2002 to June 2006 were retrospectively analyzed. All patients did not receive preoperative chemoradiotherapy, while with complete information of postoperative pathological reports and follow-up. 103 cases received radical resection followed by prophylactic radiotherapy. 86 cases with the starting time of radiotherapy≤4 weeks, 10 cases >4 weeks～≤8 weeks and 7 cases >8 weeks～≤12 weeks. 10 patients with prescription dose <50Gy/25f, 89 cases with 50～54Gy/25～27f, 4 cases with >54Gy/27f. 38 cases with target contour which include bilateral supraclavicular areas, and 65 cases with target contour which without bilateral supraclavicular areas.The prescription dose of those 78 cases who received whole conventional radio-therapy was 50～54Gy/25～27f. 22 cases with whole range 3-D CRT , the prescription dose was 50～54Gy/25～27f. 3 cases received conventional radio- therapy before 3-D CRT,which was constituted by simulator. The prescription dose was 32～40Gy/16～20f,then adding dose by 3-D CRT. The total dose was 54～60Gy/27～30f. All database was set up by Statistical Package of SPSS11.5, the survival rate was calculated using Kaplan-Meier method and the significance test by Logrank method.The comparison of groups rate usedχ2 test.Results: (1)12 cases were out of contact among these 355 cases, so the follow-up rate was 96.62%. The 1-, 3-, 5-years survival rates were 83.38%,51.55%,35.54% respectively since the surgical resection date. The average survival time and median survival time were 45.53 months and 37.30 months, respectively. 252 cases in group S, and the 1-, 3-, 5-years survival rates were 81.35%,51.98%,38.20% ,respectively,with the median survival time 37.30 months. The 1-, 3-, 5-years survival rates were 88.35%,50.49%,29.32% ,respectively, and the median survival time 37.23 months in group S+R, which include 103 cases. There was no statistical significance between two groups.The survival rate was lower in group S+R than in group S on pathological N0 stage (χ2=5.34, P=0.0209). But on N1 stage the 1-, 3-, 5-years survival rates were 92.16%,43.14%,24.62% in group S+R, which were higher than 67.03%,26.37%,7.90% in group S(χ2=8.11, P=0.0044). The survival rates were higher in group S+R in patients with positive lymph nodes number 1～2 or≥3(χ2=4.29, P=0.0383;χ2=8.81, P=0.0030). And in patients with lymph node metastasis regions one or≥2, the survival rates were higher in group S+R(χ2=4.62, P=0.0317;χ2=4.68, P=0.0305). Compared with the group S+R , the survival rates were lower in group S on pathologicalⅢorⅢ+Ⅳstage(χ2=8.86, P=0.0029;χ2=11.06, P=0.0009).(2)The total recurrence rate was 46.76%. The recurrence rate was 47.62% in group S, and 44.66% in group S+R.There was no statistical significance between two groups(P>0.05). And there were also no statistical significances between two groups about the sex, age, tumor lesion, chest or back pain,tumor invasion with nearby organs in resection, pathological T stage and postoperative pathological tumor volume grade(P>0.05). On N1stage, the local regional recurrence rate was 50.98% in group S+R ,which was lower than 71.43% in group S(χ2=5.937, P=0.018). In patients with positive lymph nodes number≥3, the local regional recurrence rate in group S+R(50.00% )was lower than in group S(79.31% )(χ2=5.030, P=0.041). While in different lymph node metastasis region(sone region and≥2 regions)there were no statistical significances between group S+R and group S(P>0.05). In patients on pathologicalⅢstage the local regional recurrence rates in group S and in group S+R were 73.97% and 51.06%, respectively, and the difference was significant(χ2=6.596, P=0.012).The local regional recurrence rate 49.06% in group S+R was lower than 70.00% in group S on pathologicalⅢ+Ⅳstage(χ2=5.915, P=0.018).(3)The total metastasis rate was 16.90%. The metastasis rate was 11.11% in group S, and 31.07% in group S+R. There was statistical significance between two group(sχ2=20.734, P=0.000). The metastasis rates were higher in group S+R on pathological T3 or T3+4 stage(χ2=18.953, P=0.000;χ2=16.062, P=0.000). In patients with postoperative pathological tumor volume>1.8cm3 , the metastasis rate 30.85% in group S+R was higher than 11.50% in group S(χ2=16.447, P=0.000), and there was statistical significances between two groups(χ2=5.030, P=0.041). In patients on pathological N0 stage the metastasis rates in group S and in group S+R were 6.21% and 28.85%, respectively(χ2=19.439, P=0.000). The metastasis rate 30.00% in group S+R was higher than 6.41% in group S on pathologicalⅡstage(χ2=19.760, P=0.000). While there were no statistical significances between two groups in different metastatic lymph node number and lymph node metastasis regions(P>0.05).Conclusions: (1) In patients with positive lymph node, postoperative pathological could decrease the local recurrence rate and improve the survival rate. Especially in patients with positive lymph nodes number≥3, postoperative pathological could decrease the local recurrence rate and then improve the survival rate significantly. (2) Postoperative pathological could decrease the local recurrence rate and improve the survival rate in patients on pathologicalⅢstage orⅢ+Ⅳstage.
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