pT_(2-3)N_(0-1)M_0期胸段食管鳞癌根治术患者的预后分析

Prognostic analysis of thoracic esophageal carcinoma patients with stage pT_(2-3)N_(0-1)M_0 after surgery

目的探讨pT_(2-3)N_(0-1)M_0期胸段食管鳞癌患者根治术后的远期生存情况及其影响因素。方法收集南京医科大学第二附属医院2011年1月至2014年3月经手术病理证实的pT_(2-3)N_(0-1)M_0期胸段食管鳞癌127例初治患者的临床及随访资料。采用单因素Kaplan-Meier法和多因素Cox风险比例回归模型分析127例接受根治手术患者的总生存期(OS)及其影响因素,应用列线图模型实现对患者个体1、3、5年生存率的数值预估。结果 127例患者术后的1、3、5年生存率分别为81.8%、54.3%、38.4%,中位OS为40.0个月(95%CI:32.285~47.715个月)。Cox多因素分析显示,pT分期(pT_2、pT_3)、pN分期(pN_0、pN_1)、有无脉管瘤栓、肿瘤直径(≤3 cm、>3 cm)是影响根治切除术后OS的独立因素,pT_3、pN_1、有脉管瘤栓和肿瘤直径>3 cm分别较对应项的生存期缩短,风险倍数分别为2.207、2.157、1.758和1.607倍(均P<0.05)。构建的列线图模型能够准确预测pT_(2-3)N_(0-1)M_0期胸段食管鳞癌个体根治术后的生存率。结论 pT_(2-3)N_(0-1)M_0期胸段食管鳞癌患者根治术后的1、3、5年生存率明显下降,预后差,其生存预后与浸润深度、淋巴结转移、脉管瘤栓、肿瘤直径4个因素密切相关,值得临床继续深入研究。

ObjectiveTo investigate the survival and its related factors of the patients with pathological stage pT_（2-3）N_（0-1）M_0 thoracic esophageal squamous cell carcinoma after resection.MethodsFrom January 2011 to March 2014 in the Second Affiliated Hospital of Nanjing Medical University,127 patients with pathological stage pT_（2-3）N_（0-1）M_0 thoracic esophageal squamous cell carcinoma after resection were enrolled.Kaplan-Meier analysis and Cox multivariate regression analysis were used to evaluate the postoperative survival and its related factors.Nomogram model was applied to implement for 1-,3-,5-year survival rate of individual patients.Results Until the end of follow-up,the 1-,3-,5-year survival rates and median overall survival（OS）were 81.8%,54.3%,38.4% and 40.0 months（95%CI：32.285-47.715）,respectively.Cox multivariate analysis revealed that stage pT（pT_2and pT_3）,pN（pN_0 and pN_1）,intravascular cancer embolus and tumor diameter（≤3 cm and3 cm）were the independent factors for OS,risk ratios of pT_3,pN_1,intravascular cancer embolus and tumor diameter3 cm were 2.207,2.157,1.758 and 1.607（P0.05）.Nomogram model could accurately predict the survival rate of pathological stage pT_（2-3）N_（0-1）M_0 thoracic esophageal squamous cell carcinoma.Conclusion The survival of thoracic esophageal squamous cell carcinoma patients with stage pT_（2-3）N_（0-1）M_0 after radical treatment shows significantly poor prognosis,the long-term survival of which is closely related to the depth of infiltration,lymph node metastasis,intravascular cancer embolus and tumor diameter,which is worthy of further study.