45例pT_4期食管鳞癌手术治疗疗效分析

Retrospective Analyses of the Efficacy of Surgical Treatment for pT4 Esophageal Squamous Cell Carcinoma

目的:依据第7版食管癌TNM分期,回顾性评价pT_4期胸中段食管鳞癌的手术治疗效果。方法:对2003年1月至2006年1月间手术治疗的45例pT_4胸中段食管鳞癌患者进行回顾性研究。全部患者经术前CT评估可实现肿瘤完全切除。采用改良lvor-Lewis手术和左胸食管癌切除术2种方式。采用Kaplan-Meier法进行生存率分析、Log-rank法比较生存率差异、Cox回归分析判定独立预后因素。结果:29例T_(4a)患者均实现肿瘤完全切除术,16例T_(4b)患者中6例实现肿瘤完全切除术(联合其他器官的扩大切除);行姑息性切除术或单纯探查术10例。患者围手术期并发症发生率为35.6%,死亡2例45例患者的总体5年生存率为17.7%。T_(4a)患者与T_(4b)患者的5年生存率分别为24.1%与6.4%(P<0.001)。肿瘤完全切除和姑息切除/单纯手术探查患者的5年生存率分别为23.5%和0(P<0.001)肿瘤姑息切除和单纯手术探查患者的5年生存率均为0(P=0.85)手术后完成辅助治疗和未完成预定治疗方案/未行辅助治疗患者的5年生存率分别为21.2%和9.1%(P=0.98)。Cox回归分析结果显示,肿瘤的不完全切除包括单纯手术探查(P=0.005)和淋巴结转移(P=0.01 8)是独立的预后不良因素。结论:对于肿瘤单纯侵及纵隔胸膜的T_(4a)食管癌患者,手术治疗疗效明显优于T_(4b)患者。对于T_(4b)患者,扩大性切除术风险性大,应该谨慎选择;

Objective： The present study aimed to examine the efficacy of surgical treatment for pT4 squamous cell carcinoma in the mid-thoracic esophagus. Methods： A retrospective study was performed on 45 patients with pT4 mid-thoracic esophageal squamous cell carcinoma. The patients were accepted for surgical treatment from January 2003 to January 2006. All patients were supposed to un- dergo complete resection according to the thoracic computer tomography. There were two different surgical approaches. One was the modified Ivor-Lewis esophagectomy, and the other was esophagectomy via the left thoracic pathway. The Kaplan-Meier method was performed to calculate the survival rate. The log-rank test was performed to compare the survival rates. Cox regression multivariate analyses were performed to identify independent prognostic factors. Results： All T4a patients underwent complete resection. Among the 16 T4b patients, 6 underwent complete resection （combined resection of the invaded organ） and 10 underwent palliative resection or exploration. The incidence rate of perioperative complications was 35.6%, and 2 patients died. The overall 5-year survival rate of the 45 patients was 17.7%. The 5-year survival rates of the %, and T4b patients were 24.1% and 6.4% （ P 〈 0,01 ）, respectively. The 5-year survival rate of the patients with complete resection was 23.5%, and that of the patients with palliative resection/exploration was 0% （ P 〈 0.01 ）. The 5-year survival rate of patients with palliative resection and with exploration were both 0 （ P = 0.85 ）. The 5-year survival rates of patients treated with and without adjuvant therapy were 21.2% and 9.1% （ P= 0.98 ）, respectively. According to the Cox regression analyses, both the incomplete tumor resection （ P 〈 0.01 ） and lymphatic metastasis （ P 〈 0.01 ） were independent risk factors of prognosis. Conclusion： After complete resection, T4, patients with tumors invading the mediastinal pleura, had better prognoses than T4a patients, For T4b patients, the surgical method must be carefully chosen because of the high risk involved. There was no significant difference patient survival between palliative resection and explorationing.