浅表食管癌术后患者的生存及预后分析

Survival and prognostic evaluation of superficial esophageal cancer after surgery

目的 评估浅表食管癌术后患者的生存率并探讨影响浅表食管癌预后的因素.方法 用寿命表法计算2007年1月1日至2011年12月31日复旦大学附属中山医院接受外科手术治疗的285例pTis～ T1期食管鳞癌患者的累计生存率.选取9个可能对浅表食管癌术后预后产生影响的因素,通过Kaplan-Meier法及COX回归模型筛选预后影响因子,估计预后指数,进行危险分层.结果 269例患者获得随访,中位随访48个月（1～92个月）.浅表食管癌患者1、3、5年的总生存率分别为97％、86％、82％.单因素分析显示病变长度、管腔狭窄、浸润深度、分化程度、淋巴结转移、脉管癌栓与预后相关.多因素分析显示浸润深度（OR=2.065,P=0.029）、淋巴结转移（OR=2.049,P=0.041）、分化程度（OR=3.828,P=0.000）、管腔狭窄（OR=2.129,P=0.048）、脉管癌栓（OR=4.222,P=0.004）为独立的预后因子;据此建立预后模型,分为低、中、高危组,3年生存率分别为95％、84％、51％,5年生存率分别为93％、79％、44％.结论 浅表食管癌预后相对较好,浸润深度、分化程度、存在管腔狭窄、淋巴结转移及脉管癌栓是独立的预后不良因子.预后不良的中、高危组患者术后生存率有待提高.

Objective To calculate the survival rate of patients with superficial esophageal squamous carcinoma who received esophageal resection and to explore factors that affect prognosis.Methods There were 285 patients with pTis-T1 esophageal carcinoma who underwent esophagectomy during 2007-2011.Their cumulative survival rates were calculated using life tables.Nine factors that may have impact on postoperative survival of superficial esophageal carcinoma were selected.The Kaplan-Meier method and COX＆#39;s regression model were used to select prognostic factors,estimate prognostic index,and establish risk stratification.Results The 1-,3-and 5-year overall survival rates of superficial esophageal carcinoma patients were 97 %,86%,and 82%,respectively.Tumor length,stenosis,depth of invasion,differentiation degree,lymph node metastasis,and vascular tumor thrombus were associated with prognosis according to univariate analysis.Depth of invasion （OR =2.065,P =0.029）,lymph node metastasis （OR =2.049,P =0.041）,differentiation degree （OR =3.828,P =0.000）,stenosis （OR =2.129,P =0.048）,and vascular tumor thrombus （OR =4.222,P =0.004） were independent prognostic factors in multivariate analysis.A prognostic models was thus established and all the patients were divided into low-risk,moderate-risk and high-risk group,with the 3-year survival rates being 95%,84%,and 51%,and 5-year survival rates being 93%,79%,and 44%,respectively.Conclusions Patients with superficial esophageal cancer have relatively favorable prognosis.Depth of invasion,differentiation degree,stenosis,lymph node metastasis,and vascular tumor thrombus may be independent factors of poor prognosis.Survival rate of moderate-and high-risk patients is yet to be improved.