进展期食管癌微创治疗术后远期疗效及预后因素分析

Analysis of long-term efficacy and prognostic factors of advanced esophageal cancer after minimally invasive esophagectomy

目的探讨进展期食管癌微创治疗术后的远期疗效及其影响预后的因素。方法进展期食管癌微创手术病人128例。观察指标包括治疗情况、术后病理结果、随访情况和预后因素分析。单因素分析采用χ^2检验,将单因素分析中P<0.05的影响因素进一步纳入cox回归模型进行多因素分析。P<0.05为差异有统计学意义。结果 128例病人均顺利完成手术,无中转开放。128例病人手术时间为(287±61)分钟,术中出血量为(134±181)ml。128例病人淋巴结清扫数目为(21±8)枚/例,均为R0切除;肿瘤直径为(4.5±2.3)cm;128例病人5年总体生存率为24.2%,无进展生存率为18.0%。单因素分析结果显示,年龄、N分期, M分期, TNM分期是影响进展期食管癌微创治疗术后5年总体生存率的相关因素,也是影响5年无进展生存率的相关因素。多因素分析结果显示,N分期, M分期, TNM分期是进展期食管癌微创治疗术后5年总体生存率和无进展生存率的独立影响因素。结论进展期食管癌微创治疗术后的远期疗效满意, N分期, M分期, TNM分期是影响术后病人总体生存和无进展生存的独立因素。

Objective To investigate the long-term efficacy and prognostic factors of minimally invasive esophagectomy of advanced esophageal cancer.Methods The clinical data of 128 cases of advanced esophageal cancer minimally invasive esophagectomy were collected.The outcome measures included treatment,postoperative pathology,follow-up and prognostic factors.One-factor analysis was conducted by χ^2 test.The influencing factors of P<0.05 in One-factor analysis were further included into cox regression model for multi-factor analysis.Results 128 patients successfully completed the operation,and none of them were converted to open.The operation time of 128 patients was(287±61)min,and the intraoperative blood loss was(134±181)ml.The number of lymph node dissection in 128 patients was(21±8)per case,all of which were R0 resection;tumor diameter was(4.5±2.3)cm;The 5-year overall survival rate of 128 patients was 24.2%,and the progression-free survival rate was 18.0%.Univariate analysis showed that age,N stage,M stage and TNM stage were related factors affecting the 5-year overall survival rate of postoperative minimally invasive esophagectomy;also,affecting 5-year progression-free survival rate.Multivariate analysis showed that N stage,M stage and TNM stage were independent influencing factors of 5-year overall survival rate and progression-free survival rate after minimally invasive esophagectomy of advanced esophageal cancer.Conclusion The long-term results of minimally invasive esophagectomy of advanced esophageal cancer are satisfactory.The tumor N stage,M stage and TNM stage are independent factors affecting the overall survival rate and progression-free survival rate of postoperative patients.