影响pT2N0-1M0期胸段食管癌患者术后疗效的因素分析

Impact factor of postoperative prognosis of esophageal cancer patients with stage pT2N0 - 1M0

目的探讨pT2NO～1M0期胸段食管癌患者的术后疗效及其影响因素。方法收集2008-2011年河北医科大学第四医院收治的275例pT2NO-1M0期胸段食管癌术后患者的临床资料，其中男180例，女95例；胸上段癌32例，胸中段癌186例，朐下段癌57例；pNO期205例，pNl期70例；单纯手术155例，术后辅助治疗120例。结果随访至2014年9月30日，全组患者的1、3、5年生存率分别为91．6％、70．2％和63．7％，1、3、5年无进展生存率分别为83．9％、64．O％和60．0％。单因素分析显示，肿瘤浸润深度、病理类型、pN分期以及阳性淋巴结数与患者的总生存有关（均P〈O．05）；患者性别、肿瘤浸润深度、病理类型、pN分期和阳性淋巴结数与患者的无进展生存有关（均P〈O．05）。Cox多因素分析显示，食管肿瘤位置和pN分期是影响患者总生存的独立因素（均P〈0．05）；患者性别、pN分期和术后辅助治疗是影响患者的无进展生存的独立因素（均P〈O．05）。结论在pT2NO～1M0期胸段食管癌术后患者中，胸上段癌和pNl期患者的预后差，建议术后辅助治疗。

Objective To investigate the postoperative prognosis and the related factors of patients with stage pT2N0-1M0 of thoracic esophageal carcinoma（EC）. Methods From 2008 to 2011, clinical data of 275 cases with stage pT2N0-1M0 of thoracic EC treated by esophagectomy were enrolled. These cases includ 180 male and 95 female. Among them, 32 cases were upper thoracic EC, 186 cases were middle thoracic EC and 57 cases were lower thoracic EC. Alternatively, 205 cases were stage pN0, 70 cases were stage pNl. 155 cases received esophageetomy alone and 120 cases received esophagectomy and postoperative adjuvant therapy. Results The end of follow-up time was on September 30th, 2014. The 1-,3-, 5-year overall survival （OS） rates were 91.6%, 70.2% and 63.7%, respectively. The 1- 3-, 5-year progression-free survival （PFS） rates were 83.9%, 64.0% and 60.0%, respectively. The result of univariate analysis showed that the depth of tumor invasion, pathological type, pN stage and number of metastatic lymph nodes were significantly associated with OS （all of P〈 0.05）. Moreover, the gender, the depth of tumor invasion, pathological type, pN stage and number of metastatic lymph nodes were significantly associated with PFS （ all of P〈 O. 05 ）. Cox multivariate analysis showed that the location of primary tumor and pN stage were the independent faetors of OS （both P〈0.05）. The gender, pN stage and postoperative adjuvant therapy were the independent factors of PFS （all of P〈0.05）. Conclusion Among the patients with pT2N0- 1M0 stage of thoracic EC, patients with upper thoracic EC or pN1 stage have poorer postoperative prognosis compared with others, and postoperative adiuvant treatment is recommended for these patients.