Ⅱ~Ⅲ期食管癌根治性切除术后患者预后的影响因素分析

Influence factors for prognosis of stageⅡ-Ⅲesophageal carcinoma patients treated with radical esophagectomy

目的探讨影响Ⅱ~Ⅲ期食管癌根治性切除术后患者预后的因素。方法回顾性分析2007年1月—2010年12月行食管癌根治性切除术且术后病理分期为Ⅱ~Ⅲ期共716例患者的临床资料。选择可能影响预后的临床病理资料及术后治疗情况进行单因素和多因素分析。结果716例患者1、3、5年总生存率分别为79.85%、58.27%、49.73%。多因素分析显示:性别、术中粘连程度、术后阳性淋巴结数目、T分期及术后辅助治疗是影响患者总生存时间(OS)的独立预后因素(均P<0.05)。对术后辅助治疗方式进行分层分析显示:Ⅱa期(342例)患者术后化疗组OS优于单纯手术组和术后放疗组(χ^2分别为9.301、4.422,P<0.05或P<0.01);Ⅱb(75例)及Ⅲ期(299例)患者术后放化疗组及术后放疗组OS均优于单纯手术组(Ⅱb期:χ^2分别为3.926、4.605,P<0.05;Ⅲ期:χ^2分别为8.504、7.435,P<0.01)。716例患者1、3、5年无进展生存率分别为71.23%、49.32%、38.26%。多因素分析显示:性别、术中粘连程度、TNM分期及术后辅助治疗是影响患者无进展生存时间(PFS)的独立预后因素(均P<0.05)。对术后辅助治疗方式进行分层分析显示:Ⅱa期患者术后化疗组PFS优于单纯手术组(χ^2=7.481,P<0.01);Ⅱb及Ⅲ期患者术后放化疗组PFS均优于单纯手术组(χ^2分别为6.684、5.741,P<0.05)。结论根治术后辅助治疗为影响Ⅱ~Ⅲ期食管癌患者预后的重要因素。Ⅱa期患者可仅行术后化疗,而Ⅱb~Ⅲ期患者接受辅助放疗或放化疗可获得更优预后。

Objective To investigate the prognostic factors of patients with stageⅡ-Ⅲesophageal carcinoma after radical esophagectomy.Methods The clinical data of 716 patients with stageⅡ-Ⅲesophageal carcinoma after radical surgery from 2007 to 2010 were retrospectively analyzed.Univariate analysis was performed by log-rank test,and multivariate analysis was performed by a Cox regression model.Results The 1-,3-and 5-year overall survival rates were 79.85%,58.27%and 49.73%,respectively.Multivariate analysis showed that gender,adhesion degree in operation,number of positive lymph nodes,T stage and postoperative adjuvant therapy were independent factors for overall survival(OS)(all P<0.05).The patients with stageⅡa(n=342)obtained better OS in postoperative chemotherapy group compared with that of operation group and postoperative radiotherapy group(χ^2=9.301 and 4.422,respectively,P<0.05 or P<0.01).The patients with stageⅡb(n=75)andⅢ(n=299)obtained better OS in postoperative chemoradiotherapy group and postoperative radiotherapy group compared with that of operation group(Ⅱb:χ^2=3.926 and 4.605,respectively,P<0.05;Ⅲ:χ^2=8.504 and 7.435,respectively,P<0.01).The 1-,3-and 5-year progression-free survival rates were 71.23%,49.32%and 38.26%,respectively.Multivariate analysis showed that gender,adhesion degree in operation,TNM stage and postoperative adjuvant therapy were independent factors for progression-free survival(PFS)(all P<0.05).The patients with stageⅡa obtained better PFS in postoperative chemotherapy group compared with that of operation group(χ^2=7.481,P<0.01).The patients with stageⅡb andⅢobtained better PFS in postoperative chemoradiotherapy group compared with that of operation group(χ^2=6.684 and 5.741,respectively,P<0.05).Conclusion Postoperative adjuvant therapy is important for the prognosis of stageⅡ-Ⅲesophageal cancer patients after radical esophagectomy.Patients with stageⅡa treated with postoperative chemotherapy and stageⅡb-Ⅲtreated with adjuvant radiotherapy or chemoradiotherapy can obtain better prognosis.