467例Ⅱ期胸段食管鳞癌切除术后患者的生存分析

Survival Analysis of Patients with Stage Ⅱ Squamous Cell Carcinoma of the Thoracic Esophagus after Esophagectomy

背景与目的:食管癌是我国常见恶性肿瘤之一,多数患者就诊时已是局部晚期。迄今为止,手术切除仍是其最主要的治疗方法。本研究旨在探讨影响Ⅱ期胸段食管鳞癌术后生存的因素。方法:回顾性分析中山大学肿瘤防治中心1990年1月至1998年12月收治的467例Ⅱ期胸段食管癌患者的临床资料,应用Kaplan-Meier法进行生存分析,组间比较用log-rank检验,多因素分析采用Cox模型。结果:全组总的1、3、5和10年生存率分别为87.1%、54.6%、43.0%和32.3%,ⅡA期和ⅡB期患者的5年生存率分别为51.0%和19.9%。81例(17.3%)术后复发,其中有70例(86.4%)在术后3年内复发。单因素分析表明患者的性别、肿瘤浸润深度、淋巴结转移、病理分期、淋巴结转移区域数、组织分化、切缘阳性和肿瘤复发均为预后影响因素。Cox回归分析显示性别、肿瘤浸润深度、病理分期、淋巴结转移区域数、切缘阳性和肿瘤复发是食管癌预后的独立影响因素。结论:影响Ⅱ期胸段食管癌患者术后生存的独立因素有性别、肿瘤浸润深度、病理分期、淋巴结转移区域数、切缘阳性和肿瘤复发。外科手术仍是ⅡA期患者的主要治疗方法,但对于ⅡB期患者应采取以手术为主的综合治疗。

BACKGROUND ＆ OBJECTIVE： Esophageal cancer is a common malignant tumor in China. At the time of diagnosis, most patients are at locally advanced stage. Up to date, surgical resection is the main treatment of esophageal cancer. This study was to analyze the correlations of clinicopathologic features of stage Ⅱ thoracic esophageal squamous cell carcinoma （ESCC） to the prognosis. METHODS： The clinicopathologic data of 467 patients with stage Ⅱ thoracic ESCC, treated with surgery from Jan. 1990 to Dec. 1998 in Cancer Center of Sun Yat-sen University, were analyzed. Cumulative survival was analyzed by Kaplan-Meier method and compared by log-rank test. The prognosis was analyzed by Cox regression model. RESULTS： The overall 1-, 3-, 5-, and 10-year survival rates were 87.1%, 54.6%, 43.0%, and 32.3%, respectively. The 5-year survival rates of patients at stage Ⅱ A and stage Ⅱ B were 51.0% and 19.9%. Of the 467 cases, 81 （17.3%） recurred, and 70 （86.4%） of them recurred within 3 years after operation. Univariate analysis revealed that the factors affecting the prognosis included gender, depth of invasion, lymph node metastasis, pathologic stage, number of lymph node metastatic fields, differentiation, positive surgical margin and tumor recurrence. Multivariate analysis showed that gender, depth of invasion, pathologic stage, number of lymph node metastatic fields, positive surgical margin and tumor recurrence were independent prognostic factors. CONCLUSIONS： Gender, depth of invasion, pathologic stage, number of lymph node metastatic fields, positive surgical margin and tumor recurrence are independent prognostic factors of stage Ⅱ ESCC. Surgery is still the primary treatment for stage Ⅱ A esophageal cancer; but surgery-dominant treatment combined with other therapies is recommended for stage Ⅱ B esophageal cancer.