【摘要】：目的:通過回顧分析經(jīng)左胸食管癌根治術術后復發(fā)進展模式,指導術后三維適形放射治療的布野設計;初步探討Tiam1在食管鱗癌術后病理組織中表達水平與預后及進展部位的相關性。方法:對經(jīng)經(jīng)左胸食管癌根治術、R0切除、病理確診的食管癌根治術后復發(fā)進展患者96例,術后分期按AJCC第7版分期標準分期。將適合術后放療設野患者分為:隆突以上復發(fā)或淋巴結轉移及吻合口復發(fā),包括雙側鎖骨上至環(huán)甲膜水平下淋巴結轉移,稱為隆突以上進展;隆突下復發(fā)轉移及腹腔淋巴結轉移,包括賁門旁、胃左、腹主動脈旁(腎動脈水平以上),稱為隆突下進展。將術后進展部位不能涵蓋在靶區(qū)內患者定義為:遠處臟器組織轉移。出現(xiàn)以上兩類或兩類以上進展,稱為復合進展。回顧分析患者復發(fā)進展模式。然后擴大隨訪病例,依據(jù)患者復發(fā)轉移部位,分為局部轉移、遠處轉移、和混合轉移,術后分期標準均依據(jù)AJCCfUICC 2010版標準分期,原發(fā)部位按AJCC/UICC2010版標準分段,依次分為胸上段、胸中段、胸下段;進展情況按復發(fā)轉移部位分為局部轉移、遠處轉移和混合轉移。局部轉移定義為包括原位復發(fā)、縱隔及鎖骨上淋巴結轉移;遠處轉移定義為除局部轉移外其它臟器組織轉移;混合轉移定義為包含局部及遠處轉移。通過免疫組織化學檢測術后病理組織Tiam1表達水平,納入306例2009年09月至2014年06月期間在揚州大學附屬醫(yī)院行根治性食管癌切除術患者,剔除11例隨訪資料不全患者后,剩余295例納入本研究最終分析。分析患者Tiam1表達水平,按免疫組化染色評分法(IRS)進行半定量,分為低、中、高表達,對比分析Tiam1表達水平與患者無病生存期(DFS)相關性及Tiam1表達水平與進展部位關系。結果:在所研究96例食管癌術后進展患者中,出現(xiàn)隆突以上進展、隆突以下進展、遠處轉移及復合進展患者分別占比53.1%、13.5%、22.9%和10.4%,以隆突以上進展者最多。對術后給予放療或放化療聯(lián)合治療患者分層分析,出現(xiàn)隆突以上進展者占比僅為37.1%。而對于術后未予放療患者,隆突以上進展者占比高達63.8%。295例患者中出現(xiàn)疾病進展236例,Tiam1高表達145例、中低表達150例,Tiam1表達水平與患者術后病理分期、淋巴結轉移狀況及T分期具備相關性,Tiam1表達水平與患者DFS時間相關,高表達患者總體預后較差,此外,對病理分期晚、高T分期及Tiam1高表達患者,結果提示與患者出現(xiàn)遠處轉移具有相關性。結論:食管癌術后進展情況以局部復發(fā)轉移為主;對于術后考慮放療的患者,給予上縱隔聯(lián)合鎖骨上野預防性照射,可能會帶來局部控制獲益,尤其對胸中上段腫瘤患者可考慮給予淋巴引流區(qū)預防性照射。ESCC根治術后,病理組織Tiam1高表達的患者預后較差;Tiam1高表達與術后出現(xiàn)遠處轉移存在相關性。
[Abstract]:Objective: to analyze the pattern of recurrence and progression after radical resection of esophageal carcinoma through left chest, and to guide the design of three-dimensional conformal radiotherapy. To investigate the correlation between the expression of Tiam1 and prognosis and progression of esophageal squamous cell carcinoma after operation. Methods: 96 patients with recurrence and progression after radical resection of esophageal carcinoma through left thoracic resection, R0 resection and pathological diagnosis, were staging according to the seventh edition of AJCC. The patients who were suitable for postoperative radiotherapy were divided into three groups: recurrence of Carina or lymph node metastasis and recurrence of anastomotic stoma, including bilateral supraclavian to cyclidine level lymph node metastasis, known as the progress of Carina; Subcarinal recurrence and abdominal lymph node metastasis, including parachordia, left stomach, abdominal aorta (above renal artery level), is called subcarinal progression. The patient who can not be covered in the target area after operation is defined as distant organ tissue metastasis. The occurrence of two or more types of progress is called compound progress. The pattern of recurrence and progression was analyzed retrospectively. Then according to the site of recurrence and metastasis, the patients were divided into local metastasis, distant metastasis, and mixed metastasis. The postoperative staging criteria were all based on AJCCfUICC 2010 standard staging, and the primary sites were divided into upper thoracic segment according to AJCC/UICC2010 standard. The progress was divided into local metastasis, distant metastasis and mixed metastasis according to the site of recurrence and metastasis. Local metastasis includes in situ recurrence mediastinal and supraclavicular lymph node metastasis; distant metastasis is defined as other organ metastasis except local metastasis; mixed metastasis is defined as including local and distant metastasis. The expression of Tiam1 in postoperative pathological tissues was detected by immunohistochemistry. 306 patients underwent radical resection of esophageal carcinoma from September 2009 to June 2014 in Yangzhou University Hospital, excluding 11 patients with incomplete follow-up data. The remaining 295 cases were included in the final analysis of this study. The expression level of Tiam1 was analyzed, and the expression of (IRS) was divided into low, middle and high expression according to the immunohistochemical staining score. The correlation between Tiam1 expression and (DFS) in disease-free survival was compared and the relationship between the expression of Tiam1 and the location of disease free survival was analyzed. Results: among the 96 patients with postoperative progress of esophageal cancer, there were more progress than Carina, and the proportion of patients with distant metastasis and compound progression were 53.1% and 10.4%, respectively. According to the stratified analysis of patients who received radiotherapy or combined radiotherapy and chemotherapy, the proportion of patients with more than protuberance was only 37.1%. However, for the patients without postoperative radiotherapy, the proportion of patients with advanced protuberance was as high as 63.8.295 cases with disease progression, 145 cases with high expression of Tiam1 and 150 cases with low expression. The expression level of Tiam1 was correlated with the postoperative pathological stage. Lymph node metastasis and T stage were correlated. The expression of Tiam1 was correlated with the time of DFS, and the overall prognosis of the patients with high expression was poor. In addition, the patients with late pathological stage, high T stage and high expression of Tiam1. The results suggest that there is a correlation with distant metastasis. Conclusion: local recurrence and metastasis are the main progression of esophageal cancer after operation, and local control may benefit from preventive radiation of upper mediastinum combined with upper clavicle field for patients who consider radiotherapy after operation. Especially for the patients with upper and middle thoracic tumors, the patients with lymphatic drainage area should be given prophylactic irradiation. After ESCC radical operation, the prognosis of patients with high expression of Tiam1 in pathological tissues was poor, and the high expression of Tiam1 was correlated with distant metastasis after operation.
【學位授予單位】：揚州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.1

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