胸段食管癌手术治疗后的死因与复发类型

Cause of death and pattern of recurrence after esophagectomy for patients with thoracic esophageal carcinomas

背景与目的:食管癌的死因包括局部浸润和/或远处转移,手术的介入会对死因产生影响。本研究对食管癌术后死亡时的复发类型及死亡原因进行总结,分析食管癌死亡时间以及导致食管癌死亡的危险因素。方法:1999年6月—2004年6月手术治疗后确诊死亡的食管癌80例,收集临床病理资料。用Spearm an法进行各个临床因素与复发类型、生存时间的相关分析;用Kap lan-M e ier法绘制生存曲线,以log-rank比较各因素对死亡时间的影响。结果:全组一年内死亡为49例(61.3%),2年内死亡为67例(83.8%)。死亡原因为纵隔内复发16例(20%),淋巴道转移30例(37.5%),血道转移为34例(42.5%)。行淋巴结清扫的复发类型以血道转移为主,与淋巴结采样的相比有明显差异,P<0.01;纵隔内复发、淋巴道转移与血道转移3组患者的生存时间无显著区别。64例肿瘤完全切除的患者,淋巴结阴性的比阳性的生存时间长(P=0.0468)。淋巴结采样的一年内死亡比淋巴结清扫的明显多,P=0.02;姑息切除的无一例活过2年。结论:血道转移、纵隔内复发及淋巴道复发都是引起食管癌死亡的重要原因,而复发类型与淋巴结切除程度有关。食管癌的完全切除及淋巴结清扫可降低局部复发,减少因局部及区域复发而导致的死亡。

Background and purpose： The cause of death for patients with thoracic esophageal carcinomas includes local recurrence and/or distant metastases. Surgical therapy to esophageal carcinomas could result in changing the cause of death. We studied the pattern of recurrence and causes of death after esophagectomy for patients with esophageal carcinoma, and analyzed the survival time and risk factors for recurrence of these patients. Methods： There were 80 patients died from esophageal carcinoma, they had been surgically treated from June 1999 to June 2004. A retrospective review was performed on the clinicopathological characteristics of these 80 dead patients. Analyses of correlation between recurrence patterns and other clinical factors were performed using Spearman＇ s method. The survival time curves were drawn by KaplanMeier method, and tested by log-rank. Results： 49 （61.3%） patients died （luring one year ＂after operation, 67（ 83.8% ） patients died （luring two year after operation, The patterns of recurrence were intra-mediastinal, lymphatic, and hematogenous in 16, 30, and 34 patients, respectively. The patients with systematic lymph node dissection more likely died of hematoge- nous metastases than lymph node sampling （P 〈0.01）. There were no difference in survival time between the regional recurrence group and the hematogenous recurrence group. In the patients with complete resection, the patients with node negative had a longer survival time than with node positive （ P = 0. 046） . There were more death （luring 1 year after surgery in patients with lymph node sampling than systematic lymph node dissection（ P =0.02）; No patients who received incomplete resection lived more than 2 years. Conclusions： The intra-mediastinal, lymphatic, and hematogenous recurrence were the causes of death after esophagectomy for the patients with thoracic esophageal carcinomas. The pattern of lymph node dissection affects the pattern of recurrence. The complete resection of tumor and extended lymphadenectomy for the thoracic esophageal carcinoma reduce the possibility of tumor local recurrence and improve the survival time.