以转移灶症状为首发表现的T_(1)、T_(2)期食管癌患者临床特征及预后分析

Clinical characteristics and prognosis analyses of metastatic sites symptom as the first manifestation in esophageal carcinoma patients with stage T_(1) and T_(2)

目的探讨以转移灶症状为首发表现的T_(1)、T_(2)期食管癌患者临床特征及预后,为临床诊疗提供参考。方法回顾性分析2007年11月至2019年12月河南省安阳市肿瘤医院收治的50例以淋巴结或远处转移为首发症状的为T_(1)、T_(2)期食管癌患者的临床资料,生存分析采用Kaplan-Meier法,单因素分析行log-rank检验。结果以淋巴结转移为首发症状就诊者42例,以远处器官转移为首发症状就诊者8例。Ⅰ~Ⅱ期和Ⅲ~Ⅳ期患者1、3、5年总生存率分别为58.7%、49.0%、16.3%和56.1%、12.2%、0,两组总生存差异无统计学意义(P=0.093),N_(1)期和N_(2)~N_(3)期患者1、3、5年总生存率为63.5%、34.7%、17.3%和52.2%、11.9%、0,两组总生存差异无统计学意义(P=0.083)。放疗组和未放疗组1、3、5年总生存率分别为64.6%、30.5%、18.3%和38.2%、0、0,两组总生存差异有统计学意义(P=0.008),放疗组无进展生存亦优于未放疗组(P=0.028)。同步放化疗组、放疗组、化疗组1、3、5年总生存率分别为70.8%、35.5%、21.3%和33.3%、0、0及35.4%、0、0,三组总生存差异有统计学意义(P=0.004)。单因素分析结果显示,是否放疗(χ^(2)=7.112,P=0.008)和同步放化疗(χ^(2)=10.940,P=0.004)是影响预后的主要因素。结论 T_(1)、T_(2)期食管癌患者即可出现淋巴结及远处转移,针对此类患者放疗可延长无进展生存期,同步放化疗可使总生存获益。

Objective To explore the clinical characteristics and prognosis of metastatic sites symptom as the first manifestation in esophageal carcinoma patients with stage T_(1) and T_(2),and to provide a reference for clinical practice.Methods The clinical data of 50 esophageal carcinoma patients with stage T_(1) and T_(2) who had lymph node or distant metastasis as the first symptom in Anyang Tumor Hospital of Henan Province from November 2007 to December 2019 were retrospectively analyzed.Survival analysis was performed by using Kaplan-Meier method.Univariate analysis was performed by using log-rank test.Results Among 50 patients with esophageal carcinoma,lymph node metastases as the first symptom were found in 42 cases and distant organ metastases as the first symptom were found in 8 cases.The 1-,3-,5-year overall survival rates of patients with stageⅠ-Ⅱand stageⅢ-Ⅳwere 58.7%,49.0%,16.3%and 56.1%,12.2%,0,respectively,and there was no statistically significant difference in OS of both groups(P=0.094).The 1-,3-,5-year overall survival rates of patients with stage N_(1) and stage N_(2)-N_(3) were 63.5%,34.7%,17.3%and 52.2%,11.9%,0,respectively,and there was no statistically significant difference in OS of both groups(P=0.083).The 1-,3-,5-year overall survival rates were 64.6%,30.5%,18.3%,respectively in radiotherapy group and 38.2%,0,0,respectively in non-radiotherapy group,and there was a statistically significant difference in OS of both groups(P=0.008);the progression-free survival in radiotherapy group was better than that in non-radiotherapy group(P=0.028).The 1-,3-,5-year overall survival rates were 70.8%,35.5%,21.3%and 33.3%,0,0 and 35.4%,0,0,respectively in concurrent chemoradiotherapy group,radiotherapy group and chemotherapy group,and there was a statistically significant difference in overall survival among three groups(P=0.004).The results of univariate analysis showed that radiotherapy(χ^(2)=7.112,P=0.008)and concurrent chemoradiotherapy(χ^(2)=10.940,P=0.004)were the main factors affecting the prognosis.Conclusions Lymph node and distant metastasis could occur in esophageal carcinoma patients with stage T_(1) and T_(2).Radiotherapy can prolong the progression-free survival time and concurrent chemoradiotherapy could benefit overall survival of these patients.