Ⅲ期胸段食管癌术后患者的预后及其影响因素

Prognosis of Patients with Stage Ⅲ Thoracic Esophageal Cancer after Operation and Its Influencing Factors

目的探讨Ⅲ期胸段食管癌术后患者生存情况及影响其预后的相关因素。方法分析224例Ⅲ期胸段食管癌术后患者的临床资料,并进行为期3年的随访,对各个因素进行Cox单因素分析,对有差异的因素进行Cox多因素回归分析,了解影响患者预后的独立因素。结果患者中位生存时间为21个月(95%CI:18. 8~23. 2),1年、2年的总生存率分别为75. 3%和39. 6%。性别、年龄、术中粘连程度、肿瘤长度、病理类型、病理残端、有无脉管瘤栓、清扫淋巴结数目、T分期对患者预后无显著影响(P均> 0. 05),而手术方式、肿瘤位置、N分期、TNM分期、术后辅助治疗,则对Ⅲ期胸段食管癌术后患者的预后有影响(P均<0. 05);进一步行多因素分析显示:手术方式、肿瘤位置对Ⅲ期胸段食管癌术后患者的预后无影响(P均> 0. 05);而N分期、TNM分期和术后辅助治疗是影响预后的独立影响因素(P均<0. 05);进一步分析发现,对患者预后有不良影响的因素有N分期(RR=1. 653)、TNM分期(RR=2. 026),术后辅助治疗为患者预后的保护因素(RR=0. 513)。结论Ⅲ期胸段食管癌术后中位生存时间约为21个月,N分期、TNM分期为影响患者预后的危险因素,而术后辅助治疗是保护因素。

Objective To investigate the survival of patients with stageⅢthoracic esophageal carcinoma after operation and the related factors affecting their prognosis.Methods The clinical data of 224 patients with stageⅢthoracic esophageal carcinoma were analyzed and followed up for 3 years,the Cox single factor analysis of each factor was carried out,Cox Multi-factor regression analysis was carried out on the different factors,and the independent factors affecting the prognosis of patients were understood.Results The median survival time of patients was 21 months(95%CI:18.8~23.2),and the total survival rate of 1 years and 2 years was 75.3%and 39.6%,respectively.Sex,age,degree of adhesion,tumor length,pathological type,pathological residual end,vascular thrombosis,number of lymph nodes,T staging had no significant effect on the prognosis of patients(P >0.05),and surgical methods,tumor location,n staging,TNM staging,postoperative adjuvant therapy,It had an effect on the prognosis of patients with stageⅢthoracic esophageal carcinoma(P<0.05).Further multi-factor analysis showed that the operation mode and tumor location had no effect on the prognosis of patients with stageⅢthoracic esophageal carcinoma(P >0.05).N Staging,TNM staging and postoperative adjuvant therapy were independent influencing factors of prognosis(P<0.05).Further analysis showed that the factors that had adverse effects on the prognosis of patients were n staging(RR=1.653),TNM staging(RR=2.026),and postoperative adjuvant therapy was the protective factor for the prognosis of patients(RR=0.513).Conclusion The median survival time of stageⅢthoracic esophageal carcinoma is about 21 months,n staging and TNM staging are the risk factors affecting the prognosis of patients,and postoperative adjuvant therapy is the protective factor.