老年食管癌患者胸腔镜根治术预后的影响因素分析

Risk factors of prognosis of thoracoscopic radical resection for esophageal cancer in elderly

目的探讨老年食管癌患者胸腔镜根治术预后的影响因素。方法回顾性分析2017年1月至2019年1月中国人民解放军联勤保障部队第九八八医院收治的79例老年食管癌患者的临床资料。79例患者均行胸腔镜根治术治疗。术后随访3年,记录患者预后情况,并依据是否存活分为死亡组及存活组,收集两组基础资料。先开展单因素分析,待获取有差异的项目后,纳入Logistic回归分析,最终获取影响老年食管癌患者手术预后的独立危险因素。结果79例患者经3年随访,共存活58例,存活率为73.42%(58/79)。单因素分析显示,年龄、肿瘤长径、分化程度、淋巴结转移、术后辅助化疗、神经侵犯与老年食管癌患者手术预后相关,差异有统计学意义(P<0.05)。多因素分析显示,年龄≥70岁、肿瘤长径≥5 cm、分化程度低分化、有淋巴结转移、术后未辅助化疗、TNM分期Ⅲ期及存在神经侵犯为影响老年食管癌患者手术预后的独立危险因素(P<0.05且OR>1)。结论老年食管癌患者胸腔镜根治术后预后一般,年龄≥70岁、肿瘤长径≥5 cm、分化程度低分化、有淋巴结转移等为影响预后的独立危险因素,临床需据此采取针对性干预,以尽可能改善患者预后。

Objective To investigate the risk factors of prognosis of thoracoscopic radical resection for esophageal cancer in elderly.Methods The clinical data of 79 elderly patients with esophageal cancer treated in the 988th Hospital of the Joint Service Support Force of the Chinese Peoples’Liberation Army from January 2017 to January 2019 were retrospectively analyzed.All patients underwent thoracoscopic radical surgery.The patients were followed up for 3 years,the prognosis was recorded,and they were divided into death group and survival group according to whether they survived.The basic data of the two groups were collected.Univariate analysis was carried out first.After obtaining the items with differences,they were included in logistic regression analysis.Finally,the independent risk factors affecting the prognosis of elderly patients with esophageal cancer were obtained.Results After 3 years’follow-up,58 cases of the 79 patients survived.The survival rate was 73.42%(58/79).Univariate analysis showed that age,tumor diameter,differentiation,lymph node metastasis,postoperative adjuvant chemotherapy and nerve invasion were correlated with the prognosis of elderly patients with esophageal cancer(P<0.05).Multivariate analysis showed that age≥70 years old,tumor diameter≥5 cm,poor differentiation,lymph node metastasis,no adjuvant chemotherapy after operation,TNM stageⅢand nerve invasion were independent risk factors affecting the prognosis of elderly patients with esophageal cancer(P<0.05 and OR>1).Conclusions The prognosis of elderly patients with esophageal cancer after thoracoscopic radical surgery is general.Age≥70years old,tumor diameter≥5 cm,low differentiation and lymph node metastasis are independent risk factors affecting the prognosis.Targeted intervention should be taken to improve the prognosis as much as possible.