中国食管癌临床流行特征及外科治疗概况大数据分析

Epidemiological characteristic and current status of surgical treatment for esophageal cancer by analysis of national registry database

目的建立中国食管癌调查数据库以了解中国食管癌的临床流行特征和外科治疗状况。方法由计算机团队和胸外科临床专家团队合作开发网络平台临床资料数据库,简称"十一五食管癌临床治疗登记数据库",授权70家合作分中心将2009-2014年经外科治疗的食管癌病例录入数据库。结果8181例资料相对完整且有随访信息的外科治疗后食管癌病例入组。男性6052例,女性2129例;平均年龄60.5岁。食管癌发病相关因素的调查结果显示,1.8%(148例)的患者有心理创伤史;92.0%(7527例)的患者只有中学以下文化程度或未接受过任何教育;62.0%(5072例)的患者不经常吃新鲜蔬菜和水果;80.0%(6544例)的患者常吃粗粮;45.5%(3722例)的患者只能饮用未经处理的水;42.0%(3436例)的患者有不良进食习惯,包括6.2%(507例)的患者吃饭快,12.2%(998例)的患者喜食烫食,23.7%(1939例)的患者喜食油炸食品;53.9%(4410例)的患者有吸烟史;34.5%(2822例)的患者有经常性饮酒史。鳞癌7813例,占95.5%;腺癌267例,占3.3%;腺鳞癌25例,占0.3%;小细胞癌50例,占0.6%。1800例(22.0%)患者因病变较晚或切除有困难接受术前辅助治疗。5870例(71.8%)患者接受左侧开胸入路手术治疗,2215例(27.1%)患者接受右胸入路手术治疗。96例(1.2%)患者接受其他途径外科治疗。8001例(97.8%)患者接受根治性手术切除治疗,180例(2.2%)患者接受姑息性手术切除治疗。术后30 d内死亡率为0.5%(43例),术后Ⅱ级以上并发症的发生率为11.6%(951例),术后1、3、5年总生存率分别为82.6%、61.6%和52.9%。结论大数据结果显示,食管癌的发生可能与不良饮食习惯、经济社会地位低、常吃粗粮、不能常吃蔬菜水果以及吸烟和饮酒等有关。但仍需要通过队列观察研究的证据支持。外科技术的提升以及综合治疗的合理应用使中国食管癌患者的长期生存率有所提高。

Objective To investigate the epidemiological characteristics and current status of surgical management for esophageal cancer in China.Methods A national database was setup through a network platform.The clinical data of esophageal cancer treated by surgery was collected from 70 major hospitals in China between January 2009 and December 2014.Results Complete data of 8181 cases of esophageal cancer patients who underwent surgery were recorded in the database and recruited in the analysis.Among them,6052 cases were male and 2129 were female,the average age was 60.5 years.The epidemiological investigation results showed that 148 cases(1.8%)had history of psychological trauma,7527 cases(92.0%)were lower social economic status,5072 cases(62.0%)were short of fresh vegetables and fruits,6544 cases(80.0%)ate rough food frequently,3722 cases(45.5%)drank untreated water directly from lake or river or shallow well,3436 cases(42.0%)had a unhealthy eating habit,including habits of eating food fast(507 cases,6.2%),eating hot food or drinking hot tea/soup(998 cases,12.2%),eating fried food(1939 cases,23.7%),4410 cases(53.9%)had the habits of smoking cigarettes and 2822 cases(34.5%)drank white wine frequently.The pathological results showed that 7813 cases(95.5%)were squamous cell carcinoma,267 cases were adenocarcinoma(3.3%),25 cases were adenosquamous cell carcinoma(0.3%)and 50 cases were small cell carcinoma(0.6%).A total of 1800 cases(22.0%)received preoperative neoadjuvant therapy due to locally advanced disease or difficulty of resection.The esophagectomies were performed through left thoracotomy approach in 5870 cases(71.8%),through right chest approach in 2215 cases(27.1%),and the remain 96 cases(1.2%)received surgery though other approaches.A total of 8001 cases(97.8%)underwent radical resection,the other 180 cases(2.2%)received palliative resection.The 30-day postoperative mortality rate was 0.5%,the overall≥gradeⅡpostoperative complication rate was 11.6%(951 cases).The 1-yr,3-yr,and 5-yr overall actual survival rates were 82.6%,61.6%,and 52.9%,respectively.Conclusions The data analysis of the national database for esophageal cancer shows that bad eating habits or eating rough food without enough nutrients,lower social and economic status,drinking white wine and smoking cigarettes frequently may be correlated with tumorigenesis of esophageal cancer.However,strong evidences produced by prospective observation studies are needed.Overall,the long-term survival of esophageal cancer patients has been improved gradually due to the application of advanced surgical techniques and reasonable multimodality treatment.