T3期胸段食管癌患者根治术后预后因素的Cox回归分析

The value of postoperative arterial infusion chemotherapy in patients with T3 esophageal squamous carcinoma after radical surgery

目的研究T3期食管癌根治术后患者的预后因素。方法1990年1月至1999年1月间进行根治性手术的T3期胸下段食管癌患者190例,分成实验组108和对照组82例,并分为3次以下化疗组56例和3次以上化疗组52例。实验组于术后3～4周动脉灌注顺铂加5氟脲嘧啶,每4～6周1次,所有患者全部随访,选择5个可能影响预后的因素数据经统计学处理。结果动脉灌注化疗组与对照组间的远期生存率无统计学差异;即使存在淋巴结转移,经动脉灌注化疗组与对照组间比较也不延长远期生存;而3次以上动脉灌注化疗可以延长T3期食管癌根治术后的远期生存。经过COX比例风险模型分析。年龄、性别、部位等不影响患者的预后,但淋巴结转移和3次以上动脉灌注化疗是影响食管癌切除术的主要因素。结论淋巴结转移和3次以上动脉灌注化疗是影响食管癌切除术后预后的重要因素。为提高预后,应常规进行区域淋巴结清扫,并于术后进行3次以上的辅助化疗。

Objective To studying the porgnostic factors after curative esophagetomy for the thoracic segment T3 esophageal after radical surgery. Methods 190 patients suffering from T3 squamous carcinoma of lower thoracic esophagus who underwent radical surgery from January 1990 to January 1999, 158 males and 32 females, aged 62.98 (40~81), were divided into 2 groups: 108 patients (experimental group, T3N0M0 56 cases and T3N1M0 52 cases) underwent surgery and arterial infusion (cisplatin 80 mg/m2 and fluorouracil (800 mg/m2) with or without epirubicin since 3~4 weeks postoperatively, the interval of each periods is 4-6 weeks. and the other 82 patients (T3N0M0 48 cases and T3N1M0 34 cases) underwent surgery only. Fifty-six out of the 108 cases in the experimental group (T3N0M0 26 cases and T3N1M0 30 cases) underwent 3 periods of chemotherapy for less than 3 periods of chemotherapy with an interval between 2 periods of 4~6 weeks, and the other 52 patients (T3N0M0 30 cases and T3N1M0 22 cases) underwent chemotherapy for 3 periods or over. All cases were followed up for more than 5 years. Kaplan-Meier survival curve was used to analyze the survival rate. Cox regression model was used to analyze the influencing factors of prognosis. Results There was no significant difference in the overall long-term survival rate between the experimental group and control group, however, the survival rate of those receiving 3 periods of chemotherapy and over was significantly higher than those receiving less than 3 periods of chemotherapy Lymph node metastatic status was an important factor in prognosis of esophageal squamous carcinoma. Conclusion Without severe side effects, postoperative chemotherapy by transcatheter arterial infusion prolongs the survival rate of the patients with esophageal squamous carcinoma who have been previously treated by radical surgery.