复发转移食管癌患者的预后因素分析

Analysis of prognostic factors in patients with recurrent and metastatic esophageal carcinoma

目的：探讨复发转移食管癌患者的预后影响因素，为患者复发转移后的临床治疗提供参考。方法回顾性分析247例食管鳞癌根治性切除术后复发转移患者的临床资料，结合随访资料进行预后因素分析。采用Kaplan-Meier法进行生存分析，组间比较采用Log rank法，以Cox比例风险模型进行多因素分析。结果247例复发转移食管癌患者中，局部复发139例（56．3％），远处转移60例（24．3％），混合型复发48例（19．4％）。247例患者的生存时间为1～42个月，中位生存时间为10个月。复发转移后1、2、3年生存率分别为26．4％、6．3％和2．4％。单因素分析显示，原发肿瘤区域淋巴结转移、远处淋巴结转移、临床分期、术后与复发转移间隔时间、复发转移方式、复发转移后治疗方法与复发转移食管癌患者的预后有关（均P＜0．05）。多因素分析显示，原发肿瘤临床分期、术后与复发转移间隔时间、复发转移方式、复发转移后治疗方法均为影响预后的独立因素（均P＜0．05）。结论复发转移食管癌患者的预后差，预后受多种因素影响，积极采用综合治疗有助于延长患者的生存时间。

Objective The aim of this study was to explore the influencing factors of prognosis for recurrent and metastatic esophageal carcinoma, and to provide reference for clinical treatment for these patients. Methods The clinicopathological and follow-up data of 247 patients with recurrent and metastatic esophageal squamous cell carcinoma after radical resection were retrospectively reviewed, combined with analysis of prognostic factors in these patients. Kaplan-Meier method was used to analyze the survival, difference between groups was compared by Log rank test, and Cox model was used for multivariate analysis. Results Among the 247 recurrent and metastatic patients, locoregional recurrence was in 139 patients （56. 3%）, distant metastasis in 60 patients （24. 3%）, and combined recurrence in 48 patients （19. 4%）. The survival time was 1 to 42 months in the 247 patients, and the median survival time was 10 months. The 1-, 3-and 5-year survival rate after recurrence and metastasis was 26. 4%, 6. 3% and 2. 4%, respectively. Univariate analysis indicated that regional lymph node metastasis of the primary tumor, distant lymph node metastasis, clinical staging, interval between operation and recurrence, recurrent and metastatic patterns, and treatment methods after recurrence and metastasis were influencing factors of prognosis （all P〈0. 05）. Cox multivariate analysis indicated that clinical staging of the primary tumor, interval between operation and recurrence, recurrent and metastatic patterns, and treatment methods after recurrence and metastasis were independent factors influencing prognosis （all P 〈0. 05）. Conclusions The prognosis of patients with recurrent and metastatic esophageal carcinoma is poor, and it is affected by many factors. Comprehensive treatment is effective in prolonging the survival time of the patients.