病变长度对淋巴结阴性食管癌患者的临床病理及预后影响

Effect of tumor length on clinicopathologied and prognosis of node-negative esophageal carcinoma patients

背景与目的:目前肿瘤长度与食管癌的预后关系争议较大,有关淋巴结转移阴性食管癌患者的不同病变长度与其临床病理资料的相关性及其对预后影响的研究报道很少。本研究探讨病变长度对淋巴结阴性食管癌患者的临床病理及预后影响。方法:回顾性分析2008年1月—2011年12月南京医科大学第一附属医院经手术病理证实的686例淋巴结阴性食管癌患者的临床病理资料及生存时间。运用SPSS软件的决策树模型决定截点(cut-off)值。采用单因素和多因素方法分析病变长度对淋巴结阴性食管癌的预后影响。结果:cut-off值3 cm以上,死亡风险明显上升。取3 cm为cut-off值,将淋巴结阴性食管癌分为cut-off值≤3 cm及>3 cm两组。两组性别、发病年龄、病变位置、病理类型、组织分化的差异均无统计学意义(P>0.05),而T分期差异有统计学意义(P<0.001),且T分期与病变长度呈正相关(r=0.373)。病变长度≤3 cm的419例患者1、3和5年生存率分别为95.7%、84.4%和76.1%,病变长度>3 cm的267例患者分别为88.3%、57.8%、46.5%,两组差异有统计学意义(P<0.001)。分别按照病变长度及T分期进行分组,≤3 cm与T1-2的生存曲线重合较好,而>3 cm与T3的生存曲线也很相近。单因素和多因素预后生存分析结果显示,病变长度为淋巴结阴性食管癌的独立预后因素(P<0.001)。结论:食管癌的病变长度与浸润深度关系密切,建议将病变长度纳入T分期,且可将≤3 cm归为T1-2分期,>3 cm归为T3分期。淋巴结阴性食管癌的病变长度是一个重要的预后因素,可以据此区分食管癌术后的高风险人群。

Background and purpose：At present, the relationship between tumor length and prognosis of esophageal carcinoma patients has been a controversial topic, and there have been few studies describing the effect of tumor length on clinicopathology and prognosis of node-negative esophageal carcinoma patients. The purpose of this study was to investigate the effect of the tumor length on clinicopathology and prognosis of node-negative esophageal carcinoma patients.Methods：The clinicopathological characteristics and survival time of 686 node-negative esophageal carcinoma patients, conifrmed by surgical pathology specimens in the First Afifliated Hospital of Nanjing Medical University from Jan. 2008 to Dec. 2010, were retrospectively analyzed. The optimal cut-off value was determined by decision tree model. Univariate and multivariate methods were used to analyze the prognostic factors of node-negative esophageal carcinoma patients.Results：In decision tree analysis, esophageal tumor length was correlated with an increasing hazard ratio for death with a cut-off value at 3 cm. No signiifcant differences were found in gender, onset age, lesion site and pathological type between 2 groups which were patients with tumor length≤3 cm and tumor length 〉3 cm （P〉0.05）. The only 1 difference between 2 groups was T stage （P〈0.001）, and tumor length had a positive correlation with T stage （r=0.373）. The 1-, 3- and 5-year survival rates of patients with tumor length≤3 cm and tumor length 〉3 cm were 95.7%, 84.4%, 76.1% and 88.3%, 57.8%, 46.5% respectively, and the difference was statistically signiifcant （P〈0.001）. Tumor length was signiifcantly associated with overall survival in univariate and multivariate analyses.Conclusion：Tumor length has close relationship with T stage in node-negative esophageal carcinoma patients. Tumor length≤3 cm could be considered as T1-2 and 〉3 cm as T3. Tumor length is an important prognostic factor for esophageal carcinoma patients without lymphatic metastasis.