目的：探讨内窥镜活检标本PCNA、cyclinD1蛋白表达和DNA含量分型同时检测对食管癌放疗预后的指导作用。方法：1979年11月至1996年12月，104例食管癌患者在我院接受术前放疗及根治性食管癌切除术，其中男64例，女40例，平均年龄51岁（31～72岁）。均用前后两野垂直照射，肿瘤剂量30～40Gy/15～20次/3～4周。结果：PCNA蛋白高表达率55.8%，cyclinD1蛋白表达阳性率为62.5%，DNA含量Ⅰ、Ⅱ型者占21.3%，Ⅲ、Ⅳ型者占78.3%。PCNA蛋白高表达者较低表达者预后好P=0.02，并与肿瘤大小、淋巴结转移状态和放疗后病理改变均有明显相关性；cyclinD1蛋白表达和 DNA含量对预后均无显著性影响且与临床病理参数无明显相关性；但cyclinD1蛋白和DNA含量之间有显著性相关p=0.03，二者结合对食管癌预后有显著性影响p=0.01；Cox模型分析显示，仅淋巴结转移状态、术前放疗剂量和放疗前PCNA蛋白表达对预后有比较明显的影响。结论：活检标本PCNA蛋白表达有可能预示食管癌预后，cyclinD1蛋白和DNA含量结合有可能成为新的评价指标。

AIM: The aim of the present study is to use immunohistochemical methods to investigate the clinical implications of tumor markers in esophageal squamous cell carcinoma and evaluate their impact on prognosis. METHODS: From November 1990 to December 1996, 47 patients were treated with preoperative radiation followed by radical esophagectomy. All patients were confirmed pathologically as suffering from squamous cell carcinoma. Immunohistochemical stain was done for PCNA, cyclinD1 protein expression and DNA content analyzed by image cytometry. Kaplan-Meier method for single prognostic factor and Log-rank test was used to test the significant difference. Cox stepwise regression model and prognosis index model were used for survival analysis with multiple prognostic factors. RESULTS: Radio-pathological change, T stage and N stage, as the traditional prognostic factors had statistical difference in 3-, 5- and 10-year survival rates. While, tumor cell proliferating marked PCNA, cyclinD1 and DNA content served as independent prognostic factors of esophageal carcinoma. There was definitely identity between the single factor and multiple factor analyses. PI was more accurate to evaluate the prognosis of esophageal carcinoma. CONCLUSION: It is possible that tumor cell proliferating marked PCNA, cyclinD1 and DNA content would become the endpoints for evaluating the prognosis of esophageal carcinoma.

To evaluate the effect and complications of esophageal carcinoma treated by external beam and intracavitary radiation with carboplatin chemotherapy. From September 1993 to May 1994, 129 advanced esophageal carcinoma patients were treated by combined radiotherapy and chemotherapy with prospective randomized study. All confirmed by pathological as squamous cell carcinoma. The follow-up rate was 98.5%. Group A: 33 patients received conventional radiotherapy. Group B: 32 patients were given external beam and intracavitary irradiation. Group C:31 patients received the external and intracavitary irradiation as same as Group B, and plus single drug carboplatin as chemotherapy. Group D: 33 patients were given external beam radiotherapy as same as group A and the chemotherapy regimen identified to group C. The 3-,4-year survival rates were significant difference between groups A and D, p=0.027 and p=0.071 respectively; The 3-year disease-free survival rates of group D 36.9% (12/33) was higher than those of group A 15.2% (5/33), p=0.048; The A, B, C and D group's median survival time were 12 months, 18 months, 13 months and 16 months, respectively. Non-carcinomatous esophageal stenosis, ulcer and fistula were the common and severe complications. There were no significant difference in any groups about the ulcer and fistula mortality, but esophageal stenosis in groups B, C were 43.8%(14/32) and 38.5%(12/31) higher than groups A, D 9.1%(3/33) and 12.1%(4/33), P<0.05. 108 patients had died. The local failure resulted in dead 63 cases (58.3%). In group A, die of local relapse 55.2%(16/29) were markedly higher than group B 22.2%(6/27), p=0.012 and group C21.4%(6/28), p=0.009. The external beam with intracavitary radiation show the local relapse down but could not improved the long-term survival, and the severe complications were markedly higher influencing the quality of life and the survival; External beam radiation plus carboplatin chemotherapy seemed to improve the survival rates and need intensive study.

目的 探讨非手术治疗的食管癌临床分期，为放化疗综合治疗方案的选择提供参考标准并准确评估预后。方法 回顾性分析单纯放射治疗的500例中晚期食管癌，根据食管钡餐X片病变长度、CT外侵程度以及病变与周围组织器官的关系，将病变局部分为T1、T2a、T2b、T3a、T3b、T4，结合区域淋巴结转移对应临床分期Ⅰ、Ⅱa、Ⅱb、Ⅲa、Ⅲb、Ⅳ期六分类法和Ⅰ、Ⅱ、Ⅲ、Ⅳ四分类法。结果 500例中晚期食管癌中，T1 23例、T2a 111例、T2b 157例、T3a 84例、T3b82例、T443例，该六组病人1、2、3、4、5年生存率均有显著性差别，X2=63.52，P=0。T2a与T2b、T3a与T3b合并后为四分类法，对应T1 23例、T2268例、T3166例、T443例，该四组病人1、2、3、4、5年生存率均有显著性差别，X2=56.29，P=0。T分期和N分期结合后分类，对应Ⅰ期21例、Ⅱa期96例、Ⅱb期139例、Ⅲa期89例、Ⅲb期87例、Ⅳ期68例，六组病人1、2、3、4、5年生存率有显著性差别，X2=94.29，P=0，组内每两组比较均接近显著性差别。TN结合后对应四分类法Ⅰ期21例、Ⅱ期235例、Ⅲ期176例、Ⅳ期68例，其1、2、3、4、5年生存率有显著性差别，X2=83.48，P=0，每两组依次比较均有显著性差别，P均<0.005。结论 中晚期食管癌临床分期的六分类法和四分类法均能较好地预示食管癌放射治疗后的预后生存，为临床应用方便，建议使用四分类法。

目的 分析中晚期食管癌单纯放射治疗的预后因素，为个体化治疗方案制定和准确评估预后提供参考标准。方法 1997年1月至1998年12月在我科接受单纯放射治疗的胸段食管癌病人500例，男318例，女182例，中位年龄56.5岁；胸上段癌195例，胸中段癌277例，胸下段癌28例；X片病变长度≤3.0cm者36例，3.1～7.0cm者318例，7.1～10.0cm者132例，>10.0cm者14例；胸部CT扫描显示病变长度≤3.0cm者14例，3.1～7.0cm者130例，7.1～10.0cm者298例，>10.0cm者58例。病变最大层面上测量肿瘤最大直径，≤2.0cm者87例，2.1～3.0cm者153例，>3.1cm者260例。应用6MV X-ray直线加速器给予一前、两后斜野等中心或源皮距照射，常规分割或后程加速超分割，总剂量60～66Gy/30～39次/5～5.3周。结果 全组1、3、5年生存率分别为71.06%、32.62%、20.81%。单因素分析显示传统预后因素性别、声哑、病变部位、病变长度、软组织阴影、溃疡和食管腔扭曲成角均明显影响预后；CT扫描相关因素如病变长度、最大外侵深度、最大直径、气管支气管受侵、降主动脉受侵、椎前三角消失和淋巴结转移也显著影响长期生存；治疗相关因素如前垂直野宽、野长、后斜野宽、野长、总剂量、总疗程时间、即时疗效和近期疗效对生存也有显著影响，均有统计学意义。Cox多因素分析显示淋巴结转移、CT显示的病变最大直径、声哑、CT显示病变长度、病变部位、病变最大外侵程度、后斜野宽度、总疗程时间、即时疗效和近期疗效均为独立性预后因素。综合多种因素的预后指数PI值越低，预后越好。结论 中晚期食管癌单纯放射治疗后，除传统预后因素外，胸部CT扫描能提供更准确的评估预后的指标，预后指数模型能够更敏感地预测疗后生存。