性别对高、低发区食管癌患者生存期的影响

Effects of Gender on Survival of Patients with Esophageal Cancer from High-and Low-incidence Areas

目的加深对食管癌关键预后影响因素的了解。方法通过入户或电话问卷调查及生存随访,采用卡方检验、Kaplan-Meier生存曲线和Log rank检验及Cox生存分析模型,分析1973—2011年间5 999例女性和9 918例男性食管癌患者的生存差异及主要影响因素。结果女性患者生存期显著高于男性(P=5.8E-25)。男性患者淋巴结转移率高于女性患者(P=2.7E-12),且T3、T4检出率明显高于女性患者,但是女性患者Tis、T1和T2检出率高于男性(P=1.2E-14);男、女性患者肿瘤分化程度相似(P=0.66)。根据TNM分期进行早、中、晚期分类,女性早期癌患者比例高于男性(13.9%vs.10.8%,P=3.8E-9),而中晚期患者的比例低于男性(86.1%vs.89.2%,P=3.8E-9)。多因素Cox回归分析提示,女性为食管癌预后生存期长的保护因素,而淋巴结转移阳性和浸润程度(T)加深为危险因素。结论女性患者生存期明显长于男性患者且为食管癌预后独立影响因素(保护因素);女性患者淋巴结转移和浸润程度(T3、T4)均低于男性检出率,是影响食管癌预后的独立危险因素。

Objective To further understand the key prognostic factors for esophageal cancer. Methods The questionnaire, home interview and / or telephone were performed for survival follow-up on esophageal cancer patients. The Chi-square test,Kaplan-Meier survival curve, Log rank test and multivariate Cox regression model were applied to assess the survival for the female(n=5 999) and male(n=9 918) esophageal cancer patients from 1973-2011.Results The survival time in female patients was signifi cantly higher than that in male(P=5.8E-25). It was noteworthy that, the rate of lymph node metastasis in male patients was higher than in female patients(P=2.7E-12).Furthermore, the prevalence of T3 and T4 in male patients was higher than that in female patients. In contrast, Tis, T1 and T2 in female patients was more common than that in male patients(P=1.2E-14). Interestingly, a similar degree of tumor differentiation was observed in male and female patients(P=0.66). Based on the TNM staging, the proportion of the patients with early stage in female was increased than that in male(13.9% vs.10.8%, P=3.8E-9).Accordingly, the proportion of middle and advanced stage in male was higher than that in female(86.1% vs.89.2%, P=3.8E-9).Cox regression analysis showed that female gender was protective factor, while with lymph node metastasis and invasion(T) deepening were risk factors for long survival of esophageal cancer.Conclusion The survival in female patients was signifi cantly longer than that in male patients. The rates of lymph node metastasis and invasion(T3, T4) in female were lower than those in male and independent factors for prognosis of esophageal cancer.