应用COX模型对食管癌切除术预后的研究

Study on survival in patients with cancer of the esophagus after resection by COX proportional hazard model

目的 探讨食管癌切除术后影响生存率的因素、确立术后生存预测模型。方法 对1985～ 1989年间 10 14例食管癌切除术病人的临床病理和随访资料进行研究。选择 13个可能对食管癌切除术预后产生影响的因素 ,通过Cox比例风险模型进行多因素分析。根据预后指数 (PI)的大小将病人分组 ,分别建立其术后生存预测模型。结果 5年随访率为 91 9%。全组 3年生存率 5 4 9% ,5年生存率 45 9% ,10年生存率 39 3 %。分析结果表明 ,影响预后的主要因素是淋巴结转移、TNM分期、肿瘤侵及深度、部位、长度和组织类型 (P <0 0 0 0 1) ;PI值小的病人预后较好。结论 食管癌的淋巴结转移状况是影响食管癌切除术后预后的最重要因素 ,要提高术后 5年生存率必须加强区域淋巴结的处理和综合治疗 ;可利用预测模型 。

Objective To study the prognostic factors in patients with cancer of the esophagus after curative resection and establish predicting models of survival rates. Methods From 1985 to 1989, 1014 patients were operated on for neoplasia of the esophagus. Thirteen possible factors influencing survival of these patients were collected. A multivariate analysis of these individual variables was performed by Cox proportional hazard model. According to the prognostic index (PI) all patients were divided into seven risk goups, and their predicting models of survival rates after resection were established for each group. Results The follow up rate was 91 9% over 5 years. The over all survival rate was 54 9%a at 3 years,45 9% at 5 years, and 39 3% at 10 years. The statistical results showed that the major significant prognostic factors influencing survival were lymph node metastases, TNM staging depth of invasion, location, length and tissue typing of the tumors (P<0 0001). Patients whithout lymph node metastases and with smaller value of PI had a better prognosis. Conclusion Lymph node metastases were the most important prognostic factor for cancer of the esophagus after resection. Esophagectomy plus with lymphadenectomy and combined therapy may improve 5 years survival rate. The survival probability may be predicted according to the predicting model of survival rates.