食管下段腺癌及Barrett食管患者的发病特征及预后影响因素

Characteristics and prognostic analysis of patients with lower esophageal adenocarcinoma and Barrett′s esophagus

目的:探讨河南省近8 a食管下段腺癌和Barrett食管患者的发病特征及预后影响因素。方法:收集2010年1月至2018年1月郑州大学第一附属医院内镜中心检查确诊的374例食管下段腺癌和365例Barrett食管患者的临床资料,观察8 a间食管下段腺癌及Barrett食管的发病特征,采用Cox回归模型分析食管下段腺癌、根治性术后食管下段腺癌的预后因素,并分析Barrett食管的转归。结果:①食管下段腺癌和Barrett食管年检出率均呈上升趋势(P<0.05)。②食管下段腺癌患者1、3、5 a总体生存率分别为67.3%、34.3%、22.5%,中位生存时间为18个月。374例食管下段腺癌患者中,104例行手术治疗,中位生存时间为56个月,270例未行手术治疗,中位生存时间为13个月。③淋巴结转移、治疗方式[手术联合化疗、单纯手术和单纯(放)化疗]是影响食管下段腺癌患者预后的独立因素(HR=1.880、0.151、0.226、0.562,95%CI=1.172~3.014、0.077~0.297、0.110~0.465、0.325~0.975,P<0.05)。④肿瘤N分期及肿瘤最大径是影响行根治性术后食管下段腺癌患者预后的独立危险因素(HR=1.727、2.288,95%CI=1.225~2.434、1.082~4.838,P<0.05)。⑤365例Barrett食管患者中,伴有特异性肠化44例,伴不典型增生17例,随访期间均未发展为腺癌。结论:食管下段腺癌发生率逐渐升高,淋巴结转移和治疗方式是影响其预后的独立因素,手术能很大程度改善患者预后;肿瘤N分期和肿瘤最大径是影响行根治性术后患者预后的独立因素。伴有不典型增生和肠化的Barrett食管患者应加强随访防止癌变。

Aim:To explore the characteristics and prognostic factors of patients with lower esophageal adenocarcinoma and related disease Barrett′s esophagus(BE)in the past 8 years in Henan Province.Methods:The clinicopathological data of 374 patients with lower esophageal adenocarcinoma and 365 patients with BE were collected in the First Affiliated Hospital of Zhengzhou University from January 2010 to January 2018.The characteristics of lower esophageal adenocarcinoma and BE in the 8 years were analyzed,and the prognostic factors analysis was done using Cox regression model.Results:The annual detection rates of the lower esophageal adenocarcinoma and BE suggested an increasing trend(P<0.05).The one-,three-and five-year overall survival rates of lower esophageal adenocarcinoma were 67.3%,34.3%and 22.5%,and the median survival time was 18 months.Among 374 patients with lower esophageal adenocarcinoma,104 patients underwent surgical treatment and the median survival time was 56 months;270 patients did not accepted surgical treatment and the median survival time was 13 months.Lymph node metastasis was an independent risk factor affecting the prognosis of patients with lower esophageal adenocarcinoma(HR=1.880,95%CI=1.172-3.014,P<0.05),and the treatment method(surgery combined with chemotherapy,surgery,and radiotherapy combined with chemotherapy)was also an independent factor(HR=0.151,0.226,0.562,95%CI=0.077-0.297,0.110-0.465,0.325-0.975,P<0.05).Tumor N stage and tumor maximum diameter were independent risk factors affecting prognosis of patients with lower esophageal adenocarcinoma after radical resection(HR=1.727,2.288,95%CI=1.225-2.434,1.082-4.838,P<0.05).Among 365 patients with BE,there were 44 patients with specialized intestinal metaplasia and 17 patients with dysplasia,but none of them developed into adenocarcinoma during follow-up.Conclusion:The incidence of lower esophageal adenocarcinoma is gradually increasing.Lymph node metastasis and the treatment method are independent factors affecting prognosis of patients with lower esophageal adenocarcinoma,and surgery can greatly improve the prognosis of patients with lower esophageal adenocarcinoma.Tumor N stage and maximum diameter are independent factors affecting prognosis of patients with lower esophageal adenocarcinoma after radical resection.Patients with BE with dysplasia and specialized intestinal metaplasia should be followed up to prevent canceration.