病理N1期胸段食管鳞癌根治术后复发转移危险因素分析

Risk factors of recurrence and metastasis in pN1 stage squamous cell carcinoma of the thoracic esophagus after radical esophagectomy with lymphadenectomy

目的 探讨病理N1（pN1）期胸段食管鳞癌患者根治性切除术后复发转移的相关危险因素.方法 回顾性分析2004年1月至2010年12月间在上海市胸科医院接受根治性切除手术且术后病理证实为pN1期的95例胸段食管鳞癌患者的临床病理资料,采用Cox比例风险模型对其术后复发转移的独立危险因素进行多因素分析.结果 95例患者中术后3年内有52例（54.7％）出现复发转移,其中局域性复发42例（44.2％）,血行转移10例（10.5％）.多因素分析结果显示, 肿瘤浸润深度（RR=3.604,P=0.027）、淋巴结转移组数（RR=4.834,P=0.009）、淋巴结转移野数 （RR=5.689,P=0.003）及术后是否接受辅助化疗（RR=1.594,P=0.048）是影响pN1期胸段食管鳞癌患者术后复发转移的独立因素.结论 辅助化疗有助于降低pN1期胸段食管鳞癌患者术后复发转移的概率.对于术前临床评估为多组或多野淋巴结转移者,诱导治疗或可进一步提高治疗效果.

Objective To analyze the clinical and pathologic risk factors of early recurrence in patients with pathological N 1 （pN 1）stage esophageal squamous cell carcinoma after radical esophagectomy.Methods A retrospective study was carried out on 95 consecutive pN1 stage esophageal squamous cell carcinoma patients undergoing esophagectomy with lymphadenectomy by the same surgical team from January 2004 to December 2010 was performed.The Cox proportional hazards model was used to determine the independent risk factors for recurrence and metastasis within 3 years after the operation.Results Recurrence was indentified in 52 patients （54.7%） within 3 years after operation.Local recurrence was found in 42 patients （44.2%）,and distant metastasis in 10 patients （10.5%）.The Cox multivariate analysis showed that pT3-4a stage （RR=3.604,P=0.027）,positive lymph node metastasis in two stations （RR=4.834,P=0.009） or two fields （RR=5.689,P=0.003）,and postoperative adjuvant chemotherapy （RR =1.594,P=0.048） were independent risk factors for postoperative recurrence.Conclusions Postoperative adjuvant chemotherapy can decrease the probability of postoperative recurrence and metastasis of pN1 esophageal squamous cell carcinoma.As for patients who are indentified as multi-station or multi-field lymph node metastasis,preoperative induced therapy maybe further improve treatment outcomes.