食管胃结合部腺癌患者术后预后影响因素研究

Factors Influencing the Postoperation Prognosis of Patients with AGEJ

目的探讨食管胃结合部腺癌(adenocarcinoma of gastroesophageal junction,AGEJ)患者术后预后影响因素,为临床决策提供依据。方法收集2010年1月至2019年10月濮阳市人民医院收治的行手术治疗的临床病理资料及随访资料完整的AGEJ患者255例。采用Kaplan-Meier法对患者年龄、性别、吸烟、浸润程度、淋巴结转移及是否术后化疗等14项指标行单因素分析、log-rank检验,将可疑预后影响因素纳入Cox比例风险模型多因素分析筛选出术后预后的独立影响因素,以P<0.05为差异有统计学意义。结果255例患者平均生存时间为59.7个月,中位生存时间为54.0个月;总体1、3和5 a生存率分别为85.0%、62.7%和44.7%。单因素分析结果显示,肿瘤最长直径、分化程度、浸润程度、淋巴结转移情况、有无癌栓、切缘状况、有无术后辅助化疗与AGEJ患者术后预后有关(均P<0.05),年龄与预后无关。Cox比例风险模型多因素分析结果显示,浸润程度(P=0.000,OR=2.304,95%CI=1.531~3.466)、淋巴结转移情况(N2:P=0.015,OR=2.019,95%CI:1.149~3.549;N3:P=0.000,OR=3.779,95%CI:2.257~6.327)、术后辅助化疗(P=0.000,OR=2.289,95%CI:1.534~3.414)为AGEJ患者术后预后的独立影响因素。结论年龄大小不影响术后生存期;肿瘤浸润程度、淋巴结转移情况是患者术后预后重要独立影响因素;术后辅助化疗可显著延长患者生存期。

Objective To explore the influencing factors of postoperation prognosis of adenocarcinoma of gastroesophageal junction(AGEJ)patients and provide basis for clinical decision-making.Methods 255 cases of AGEJ patients with complete clinicopathological data and follow-up data of surgical treatment,admitted to Puyang People’s Hospital from January 2010 to October 2019,were collected.The kaplan-Meier method was used to perform univariate analysis on 14 indicators including age,gender,smoking,degree of infiltration,lymph node metastasis,and postoperative chemotherapy,Log-rank test was performed,and the suspected prognostic factors were included in Cox proportional hazard model multivariate analysis to screen out independent prognostic factors.P<0.05 was considered statistically significant.Results The mean survival time of the 255 cases of AGEJ patients was 59.7 months and the median survival time was 54.0 months.Overall 1-,3-and 5-year survival rates were 85.0%,62.7%and 44.7%,respectively.The results of univariate analysis showed that the maximum tumor diameter,degree of differentiation,degree of infiltration,lymph node metastasis,the presence of tumor thromboembolus,the condition of resection margin,and the presence of postoperative adjuvant chemotherapy(P<0.05,respectively)were correlated with the postoperation prognosis of AGEJ patients,age was not associated with the prognosis of AGEJ patients.Cox proportional hazard model multivariate analyses showed that the degree of infiltration(P=0.000,OR=2.304,95%CI=1.5~3.466),lymph node metastasis(N2:P=0.015,OR=2.019,95%CI=1.149~3.549;N3:P=0.000,OR=3.779,95%CI=2.25~6.327)and postoperative adjuvant chemotherapy(P=0.000,OR=2.289,95%CI=1.534~3.414)were independent influencing factors of postoperation prognosis of AGEJ patients.Conclusion Age does not affect postoperative survival of AGEJ patients;the degree of tumor invasion and lymph node metastasis are important independent influencing factors of postoperation prognosis of AGEJ patients;postoperative adjuvant chemotherapy can significantly prolong the postoperative survival of patients.