食管癌患者术后肿瘤复发和转移的危险因素分析

Risk Factors for Recurrence or Metastasis of Tumor in Patients with Esophageal Carcinoma after Esophagectomy

目的探讨影响食管癌患者术后导致肿瘤复发、转移的危险因素,为临床制定术后治疗方案提供依据。方法对2002年1月至2005年1月在甘肃省肿瘤医院行食管癌手术切除的出院患者533例进行随访。纳入随访资料完整、术后生存5年以上并无确切复发、转移的124例患者作为长期生存组,其中男105例,女19例;平均年龄64岁。术后1年内由于肿瘤复发、转移而死亡的62例患者作为短期生存组,其中男56例,女6例;平均年龄62岁。采用单因素分析筛选肿瘤复发、转移的潜在危险因素,进行logistic回归多因素分析筛选危险因素,应用Spearman相关分析法进行相关分析。结果单因素分析结果显示,两组肿瘤长度(χ2=13.459,P=0.001)、肿瘤根治程度(χ2=42.470,P=0.000)、肿瘤分化程度(χ2=11.010,P=0.004)、肿瘤浸润深度(χ2=66.577,P=0.000)、残端情况(χ2=42.740,P=0.000)、有无淋巴结转移(χ2=60.043,P=0.000)以及淋巴结转移数(χ2=72.901,P=0.000)差异均有统计学意义。多因素分析显示肿瘤分化程度[OR=2.444,95%CI(1.205,4.957),P=0.013]、肿瘤浸润深度[OR=6.145,95%CI(3.022,12.495),P=0.000]、有无淋巴结转移[OR=12.151,95%CI(4.961,29.763),P=0.000]、淋巴结转移数[OR=11.935,95%CI(3.492,23.541),P=0.000]和残端情况[OR=13.081,95%CI(2.043,83.775),P=0.007]与食管癌患者预后明显相关。相关分析发现肿瘤浸润深度与有无淋巴结转移呈正相关(r=0.496,P<0.001),肿瘤浸润深度与有淋巴结转移数呈正相关(r=0.519,P<0.001)。结论肿瘤分化程度、肿瘤浸润深度、淋巴结转移和残端情况是影响食管癌患者复发、转移和生存时间的关键因素。目前食管癌TNM分期未能完全反映对预后的影响和指导制定术后综合治疗方案,应从多方位分析相关恶性度生物学行为。

Objective To investigate the prognostic factors of postoperative recurrence or metastasis of esophageal squamous cell carcinoma （ESCC） and provide a basis for devising a treatment plan. Methods Between January 2002 and January 2005, 533 patients with esophageal squamous cell cancer who underwent surgical resection and two-field lymphadenectomy in Gansu Tumor Hospital were followed. Of them, 124 patients with 105 males and 19 females and average age of 64 years, survived for more than 5 years without any evidence of recurrence or metastasis （the long-term survival group）, and 62 patients with 56 males and 6 females and average age of 62 years, developed recurrence or metastasis and died within 1 year （the short-term survival group）. The risk factors for recurrence or metastasis of tumor of the two groups were analyzed by univariate analysis and logistic regression. Spearman analysis was also conducted. Results Univariate analysis demonstrated that significant differences existed between the groups in tumor size（x2 =13. 459,P=0. 001）, radicality of resection（x2=42. 470,P=0. 000）, grade of differentiation（x2 =11. 010, P=0. 004）, pT-stage（xz =66. 577,P=0. 000）, margin status（x2 =42, 740,P=0. 000）, lymphnode metastasis（x2 = 60. 043, P= 0. 000）, and number of lymph nodes involved（x2 = 72. 901, P=0. 000）. Multivariate analysis showed that the grade of differentiation at odds ratio（OR） 2. 444 with 95% confidence interval （CD1. 205 to 4. 957 and P=0. 013, lymph node metastasis （OR 12. 151 with 95%CI 4. 961 to 29. 763, P=0. 000）, number of lymph nodes involved （OR 11. 935 with 95 % CI3. 492 to 23. 541, P=0. 000）, and margin status （OR 13. 081,95%CI 2. 043 to 83. 775, P= 0. 007） were the key factors influencing patient prognosis. Positive correlations were found between pT-stage and lymph node status （r= 0. 496, P〈0. 001）, as well as between pT-stage and number of lymph nodes involved （r= 0. 519, P〈0. 001）. Conclusions The grade of tumor differentiation, pathology stage, lymphnode metastasis status, and margin status are the main influencing factors in recurrence or metastasis and survival time of patients with ESCC.