内镜下肿瘤特征与食管早期癌根除术患者预后效果的相关性分析

Endoscopic Tumor Characteristics and Its Correlation with Prognosis of Patients after Eradication of Early Esophageal Cancer

目的探讨内镜下肿瘤特征与食管早期癌根除术患者预后效果的相关性。方法选取2008年1月至2010年1月徐州医学院附属淮安医院消化科收治的食管早期癌患者90例为研究对象，均接受食管癌根除术治疗，随访记录5年生存中位数，分析性别、年龄及内镜下肿瘤特征对患者预后的影响。结果食管早期癌患者的年龄、性别及肿瘤位置差异对患者的预后无显著影响，而病理类型、内镜下肿瘤大小、脉管瘤栓及淋巴结转移个数为影响预后的危险因素。进一步采用COX比例风险模型分析，内镜下肿瘤直径（0R=2．190，95％CI1．258～2．574）与脉管瘤栓（OR=3．982，95％CI2．421～4．527）是影响患者预后的独立危险因素。分层分析结果显示，肿瘤直径≥2．8cm的无脉管瘤栓患者术后5年中位生存期（48个月）显著短于肿瘤直径〈2．8em的无脉管瘤栓患者术后5年中位生存期（〉60个月），差异有统计学意义（P〈0．05）；而肿瘤直径≥2．8cm和肿瘤直径〈2．8cm的有脉管瘤栓患者术后5年生存中位生存时间分别为43个月和42个月，两组比较差异无统计学意义（x2=0．22，P〉0．05）。结论内镜下肿瘤直径是影响食管早期癌根除术患者预后效果的因素；对于无脉管瘤栓的患者，内镜下肿瘤直径≥2．8cm患者的预后效果较差。

Objective To analyze the correlation of endsocopic tumor characteristics and prognosis in patients with early esophageal cancer eradication surgery. Methods Total of 90 patients with early esophageal cancer in Department of Gastroenterology of Huai＇an Hospital Affiliated to Xuzhou Medical College from Jan. 2008 to Jan. 2010 were selected, all the patients received treatment of esophageal cancer eradication. 5-year median survival was followed up and recorded. The influence of age, gender and endoscopic tumor characteristics on prognosis were analyzed. Results The age, gender and endoscopic tumor location had no significant effect on prognosis, but pathology, endoscopic tumor size, vascular invasion and lymph node metastasis number were risk factors for prognosis. Endoscopic tumor diameter （OR = 2. 190,95% CI 1. 258- 2. 574） and vascular invasion （OR = 3. 982,95% CI 2. 421-4. 527 ）were the independent risk factors for prognosis of patients by further analysis of COX proportional hazard mode. Stratified analysis showed that 5-year median survival of patients with tumor diameter≥2.8 cm without vascular invasion（48 months） were significantly lower than patients with tumor diameter 〈 2. 8 cm without vascular invasion （ 〉 60 months） （ P 〈 0. 05 ）. The 5-year median survival of patients with tumor diameter≥2.8 cm and vascular invasion was 43 months and of patients with tumor diameter 〈 2. 8 cm and vascular invasion was 42 months, the difference was not statistically significant （ x2 = 0. 22, P 〉 0.05 ）. Conclusion Endsocopic tumor diameter is the prognostic factor in patients with early esophageal cancer. Patients with no vascular invasion with tumor diameter t〉2. 8 cm have poorer prognosis.