The clinical significance of adjuvant radiotherapy in Mucin1 mRNA-positive patients following Ivor-Lewis esophagectomy in esophageal cancer / 中华胸心血管外科杂志

ABSTRACT

Objective To investigate whether Ivor-Lewis esophagectomy combined with adjuvant radiotherapy prevents lymphatic metastatic recurrence in esophageal cancer patients.Methods 113 Stage Ⅱ A esophageal squamous cell carcinoma patients after Ivor-Lewis esophagectomy were accpected mRNA expression of Mucin1 gene detection.Positive patients were enrolled into adjuvant radiotherapy group(with postoperative adjuvant radiotherapy).Negative patients were enrolled into control group (without postoperative adjuvant radiotherapy or chemotherapy).The radiotherapy area consisted of the neck,supraclavicular region and the superior mediastinum(including praesophageal and pratracheal region).Survival difference was compared by x2 test,the Kaplan-Meier method was performed to calculate the survival rate and recurrence rate.Logistic regressive analysis was performed to determined independent risk factors.Results The radiotherapy area lymphatic metastatic recurrence rate in adjuvant radiotherapy group(16.7％,5/30) was lower than patients without postoperative adjuvant radiotherapy (45.8％,38/83) (P ＜ 0.05).Only compared to positive patients without postoperative adjuvant radiotherapy(60.0％,6/10),the rate (16.7％,5/30) was significantly lower(P ＜ 0.01).Cancer recurrence was recognized in 48.6％ (55/113) patients within 3 year after operation,including 38.1％ (43/113) patients with radiotherapy area recurrence.In logistic analysis the T status (P＜ 0.01) and adjuvant radiotherapy (P ＜ 0.05) were independent risk factors of lymph node metastasis in the first 3 years after operation.Conclusion In Mucin1 mRNA-positive esophageal squamous cell carcinoma patients,adjuvant radiotherapy could significantly reduce the lymph node metastasis rate in the radiotherapy area after Ivor-Lewis esophagectomy.Compared with traditional therapeutic methods,Ivor-Lewis esophagectomy combined with adjuvant radiotherapy can achieve similar curative effects in Mucin1 mRNA-positive patients.