摘要目的 观察术前放化疗对中晚期食管鳞癌(ESCC)患者病理分期和预后的影响.方法 1997年至2007年,477例晚期食管鳞癌随机分为4组:术前化疗组、术前放疗组、术前放化疗组及单纯手术组(对照组),对比各组切除率、病理分期、相关并发症及生存率.结果 术前放疗组及术前放化疗组与对照组对比,根治性切除率提高(P＜0.05),且术后病理分期显著降期(50.8%、54.2%比0%,P＜0.05),而术前化疗组与对照组对比,切除率及病理分期均无显著改善.各组新辅助疗法相关并发症与对照组对比差异无统计学意义(P＞0.05).3年生存率术前放疗组、术前放化疗组及对照组分别为69.5%、72.9%、53.4%,对比差异有统计学意义(P＜0.05).术前放疗组、术前放化疗组与对照组5年生存率对比差异有统计学意义(P＜0.05),放化疗组高于放疗组,但差异无统计学意义(P＞0.05).结论 合理应用术前放化疗可有效提高中晚期食管鳞癌患者的根治性切除率及生存率.

abstractsObjective To evaluate the effects of preoperative radiochemotherapy on pathological staging and prognosis in the patients with advanced esophageal squamous carcinoma(ESCC). Methods 1997-2007,477 patients with advanced ESCC were randomized into four groups:neoadjuvant chemothera-py, neoadjuvant radiotherapy, neoadjuvant radiochemotherapy, and surgery alone (control group). The tumor resection rate, pathological stage, treatment-related complication, and survival among groups were compared. Results The radical resection rate for the patients in radiotherapy and radiochemotherapy groups was increased in comparison with the control group (P ＜ 0.05). Their pathological stage after esophagectomy was regressed significandy than that of the control group (50.8% ,54.2% vs 0% ,P ＜0.05). The chemotherapy group showed significant improvement on resection rate and pathological staging compared with the control group. The treatment related complication in three neoadjuvant groups had no significant difference from that of the control group (P ＞ 0. 05). The 3-year survival rate of radiotherapy and radiochemotherapy groups were significantly higher than that of the control group(69.5% ,72.9% vs 53.4%, P ＜ 0.05). The 5-year survival rate of radiochemotherapy and radiotherapy groups were was high-er than that of the control group(P ＜ 0.05), meanwhile the 5-year survival rate of radiochemotherapy was higher than that of radiotherapy group, but no statistical difference (P ＞ 0. 05). Conclusion Preoperative radiochemotherapy seems to provide an efficient therapy in radical resection and survival of patients with advanced ESCC.