Ⅳ期SiewertⅡ型食管胃结合部腺瘤患者姑息性手术的临床意义:基于SEER数据库的回顾性研究

Clinical value of palliative resection in patients with stage Ⅳ Siewert type Ⅱadenocarcinoma of the esophagogastric junction:a retrospective study based on the SEER database

目的探讨姑息性手术对Ⅳ期SiewertⅡ型食管胃结合部腺瘤(AEG)患者预后的影响。方法通过SEER*Stat软件收集2004—2015年病理诊断为Ⅳ期SiewertⅡ型AEG的病例4337例,其中手术组患者341例,非手术组患者3996例。运用倾向得分匹配(PSM)平衡组间差异,采用Cox比例风险模型、Kaplan-Meier分析研究患者的预后特点。结果Cox单因素分析发现,手术、年龄、放疗、化疗、肿瘤T分期以及分化程度均可能是影响Ⅳ期SiewertⅡ型AEG患者预后的相关因素(P﹤0.05)。Cox多因素分析显示,手术、化疗、分化程度Ⅲ~Ⅳ级、T4期、高龄均是患者的总生存(OS)和肿瘤特异性生存(CSS)的危险因素。Kaplan-Meier生存曲线分析提示,手术组患者OS与CSS均优于非手术组(P﹤0.05)。结论姑息性手术可以改善Ⅳ期SiewertⅡ型AEG患者OS及CSS,推荐晚期患者采取姑息性手术联合全身化疗的治疗策略。

Objective To investigate the effect of palliative resection on the prognosis of patients with stage Ⅳ Siewert type Ⅱ adenocarcinoma of the esophagogastric junction(AEG). Method The data of 4337 patients with definite pathological diagnoses of stage Ⅳ AEG were collected from the SEER database from 2004 to 2015 by using SEER*Stat software, 341 patients underwent palliative resection, and 3996 patients were not. The propensity score matching(PSM) was used to balance the clinicopathological characteristics between two groups. Cox regression model, and Kaplan-Meier analysis were used for studying the patient’s prognosis. Result Cox univariate analysis showed that operation, age, radiotherapy, chemotherapy, tumor T stage and degree of differentiation may be related factors affecting the survival and prognosis of patients with Siewert type Ⅱ AEG(P<0.05). Cox multivariate analysis showed that surgery, chemotherapy, differentiation grade Ⅲ-Ⅳ, T4 and advanced age were risk factors for OS and CSS. Kaplan-Meier survival curve analysis showed that OS and CSS in the operation group were better than those in the non operation group(P<0.05). Conclusion Palliative resection can improve OS and CSS of patients with stage IV Siewert type Ⅱ AEG. Palliative resection combined with systemic chemotherapy is recommended for patients with stage Ⅳ AEG.