摘要目的:比较新辅助化疗和辅助化疗对食管鳞状细胞癌根治性切除患者远期生存的影响。方法:回顾性分析2005年1月至2015年1月于河北医科大学第四医院胸外科接受根治性切除的1 082例T3~4aN0~3M0期胸段食管鳞状细胞癌患者的临床和病理学资料。男性798例，女性284例，中位年龄61岁（范围：37~86岁）。138例接受新辅助化疗联合手术，392例接受手术联合辅助化疗，552例接受单纯手术。将新辅助化疗组分别与辅助化疗组和单纯手术组按1∶3的比例进行倾向性评分匹配，纳入肿瘤位置、淋巴结阳性状态、浸润深度、分化程度、手术方式、脉管瘤栓及神经受侵情况共7个协变量，卡钳值取0.1。完成匹配后，共699例纳入分析，包括新辅助化疗组128例，辅助化疗组267例，单纯手术组304例。采用Kaplan-Meier法绘制各组生存曲线，并以Log-rank检验进行组间比较。结果:匹配后新辅助化疗组5年总体生存率为41.5%，中位总体生存时间43个月（95% CI：27~59个月），辅助化疗组分别为57.6%和未达到，单纯手术组分别为24.9%和28个月（95% CI：25~31个月）（χ2=60.475， P<0.01）。总体生存时间两两比较，辅助化疗组优于新辅助化疗组（χ2=11.384， P=0.001），新辅助化疗组优于单纯手术组（χ2=8.654， P=0.003），辅助化疗组优于单纯手术组（χ2=60.234， P<0.01）。 结论:新辅助化疗和辅助化疗均能改善接受根治性切除的局部进展期食管鳞状细胞癌患者的远期生存，辅助化疗改善效果更明显。

abstractsObjective:To compare the effects of preoperative neoadjuvant chemotherapy and postoperative adjuvant chemotherapy on the long-term survival of patients with radical resection for esophageal squamous cell carcinoma.Methods:Totally 1 082 patients with stage T3-4aN0-3M0 thoracic esophageal squamous cell carcinoma were recruited in this study who underwent radical resection at Department of Thoracic Surgery, Fourth Hospital, Hebei Medical University from January 2005 to January 2015. There were 798 males and 284 females, with a median age of 61 years (range: 37 to 86 years). There were 138 patients undergoing preoperative neoadjuvant chemotherapy, 392 patients postoperative adjuvant chemotherapy, and 552 patients surgery alone. The neoadjuvant chemotherapy group was used as the benchmark group to match the propensity score with the adjuvant chemotherapy group and the surgery-only group respectively at a ratio of 1∶3. A total of 7 covariates including tumor location, number of positive lymph nodes, tumor invasion depth, tumor differentiation degree, surgical procedure, vascular tumor thrombus and nerve invasion were included, and the caliper value was taken as 0.1. After matching, a total of 699 patients were included for the analysis, including 128 patients in the neoadjuvant chemotherapy group, 267 patients in the adjuvant chemotherapy group, and 304 patients in the surgery alone group. The Kaplan-Meier method was used to generate the survival curves which was tested by the Log-rank method for survival analysis.Results:After matching analysis, the 5-year overall survival rate was 41.5% in the neoadjuvant chemotherapy group with a median overall survival time of 43 months (95% CI: 27 to 59 months), 57.6% in the adjuvant chemotherapy group with a median overall survival time unreached, and 24.9% in the surgery alone group with a median overall survival time of 28 months (95% CI: 25 to 31 months) (χ2=60.475, P<0.01). For overall survival after matching, the adjuvant chemotherapy group was better than the neoadjuvant chemotherapy group (χ2=11.384, P=0.001), the neoadjuvant chemotherapy group was better than the surgery alone group (χ2=8.654, P=0.003), and the adjuvant chemotherapy group was better than surgery alone group (χ2=60.234, P<0.01). Conclusion:Both preoperative neoadjuvant chemotherapy and postoperative adjuvant chemotherapy can improve the long-term survival of patients with locally advanced esophageal squamous cell carcinoma undergoing radical resection, and the improvement effect of postoperative adjuvant chemotherapy is more obvious.