食管癌为第一原发癌的双原发癌患者预后分析

Overall survival analysis of double primary cancer patients with esophageal cancer as the first primary cancer

目的探索以食管癌为第一原发癌的双原发癌患者的预后因素。方法用美国国立癌症研究所SEER数据库,确定并收集2004至2013年组织病理诊断明确的以食管癌为第一原发癌的双原发癌患者临床资料。通过Kaplan-Meier生存分析及对数秩检验绘制生存曲线。通过COX比例风险模型分析患者的独立预后因素。结果共收集了540名患者的临床资料,其中同时性双原发癌患者256名,异时性双原发癌患者284名。同时性双原发癌组中,25.4%的患者食管癌为局部性病变,32.8%的患者食管癌为区域性病变。而在异时性双原发癌组中,患者食管癌为局部性病变和区域性病变的分别占43.7%和39.8%。异时性双原发癌组患者生存率较同时性双原发癌组患者显著增高(P<0.001),而对第一、二原发癌均进行手术治疗有益于改善两组患者预后。结论晚期食管癌患者更容易出现同时性双原发癌。同时性/异时性分组是以食管癌为第一原发癌的双原发癌患者的独立预后因素,而是否对第一或第二原发癌进行手术治疗与患者总生存率密切相关。

Objective To investigate the prognostic factors of double primary cancer patients with esophageal cancer as the first primary cancer.Methods Using the National Cancer Institute SEER database,clinical data of patients with double primary cancer with esophageal cancer as the first primary cancer diagnosed by histopathology from 2004 to 2013 were identified and collected.Kaplan-Meier survival analysis and log-rank testing were applied to compare survival curves.The Cox proportional hazard model was used to analyze the independent prognostic factors.Results Clinical data of 540 patients were collected,including 256 patients with synchronous primary cancer(SPC)and 284 patients with metachronous primary cancer(MPC).In the SPC group,25.4%of the patients had local esophageal cancer and 32.8%had regional esophageal cancer.In the MPC group,local and regional esophageal cancer accounted for 43.7%and 39.8%,respectively.The survival rate of patients in the MPC group was significantly higher than that in the SPC group(P<0.001).Surgical treatment for the first and second primary cancers was beneficial to improve the prognosis of patients in both groups.Conclusion Patients with advanced esophageal cancer are more likely to develop SPC.SPC/MPC grouping is an independent prognostic factor for double primary cancer patients with esophageal cancer as the first primary cancer,and surgical treatment for the first and second primary cancer is associated with overall survival.