伴有淋巴结转移的胸段食管鳞癌(T_(1～4)N1M0)患者155例的多因素生存分析

Survival analysis of 155 esophageal squamous carcinoma patients with metastastic lymph nodes(T_(1～4)N1M0)

目的:探讨不同浸润深度及转移淋巴结数目对伴有淋巴结转移的胸段食管(N1)患者的预后影响,揭示同一病理分期下不同预后的病理基础及探讨合理的术后辅助治疗方案.方法:应用Cox模型及Kaplan-Meier生存曲线等对患者的术后临床病理及随访资料进行多因素分析.结果:155例患者,其中T1N1者2例,T2N1者46例,T3N1者103例,T4N1者4例.淋巴结转移数目小于4枚患者的(n=113)1,3,5 a生存率与大于4枚者(n=42)有统计学差异(P<0.05),患者的年龄、肿瘤部位等因素与术后生存无关(P>0.05).扩大的淋巴结清扫方式及目前不规范的术后辅助治疗未显现明显的生存获益.结论:转移淋巴结数目是影响患者预后及生存的重要因素.术后辅助治疗及扩大的淋巴结清扫方式对生存的改善则需要进一步多中心随机对照研究证实.

AIM： To investigate the effect of tumor invasive depth and number of metastatic lymph nodes on the prognosis of patients with stage N1 thoracic esophageal squamous cell carcinoma and to explore the pathological mechanism of different prognosis and proper postoperative adjuvant therapy. METHODS ： Clinieopathological and follow-up data of 155 patients, who had undergone simple resection of thoracic esophageal squamous cell carcinoma, were studied using Kaplan-Meier survival curves and Cox-model analysis. RESULTS： Among all the 155 cases, 2 were staged to T1N1,46 to T2N1, 103 to T3N1, and 4 to T4N1. The 1, 3 and 5-year survival rates of patients who had less than 4 metastatic lymph nodes were significantly higher than those who had more than 4 （ P 〈 0.05 ）. But, no obvious statistical signifi-cancé was found in sex, age, tumor site or cellular differentiation. CONCLUSION ： The number of metastatic lymph nodes is a vital factor influencing the prognosis and survival of patients with tho-racic esophageal squamous cell carcinoma. However, multi-center randomized control test is needed to prove the benefit of postopera- tive treatment and extended lymph node dissection.