根治手术治疗pT_(2-3)N_(0-1)M_(0)期胸段食管鳞癌的临床预后分析

Analysis of clinical prognosis for radical surgery in patients with pT_(2-3)N_(0-1)M_(0)stage thoracic esophageal squamous cell carcinoma

目的探讨pT_(2-3)N_(0-1)M_(0)期胸段食管鳞癌患者根治术后的预后生存状况及影响因素。方法选取2017年1月—2019年11月于新疆医科大学第一附属医院行根治手术治疗的138例pT2-3N0-1M0期胸段食管鳞癌患者,回顾性整理分析所有患者临床及随访资料。患者在手术治疗后1年内需3~6个月复查1次,之后6~12个月复查1次,3年后复查改为每年1次。全组患者术后随访至2022年12月。统计患者治疗后局部复发、淋巴结转移、生存等预后情况,使用Logistic回归分析影响pT2-3N0-1M0期胸段食管鳞癌患者预后的因素。结果138例患者中129例患者完成随访,随访率为93.48%;术后3年内预后不良患者78例,预后良好患者51例,预后不良率为60.47%。不同预后患者的年龄、性别构成、肿瘤位置、术后是否辅助化疗及组织学分化程度比较,差异均无统计学意义(P>0.05);预后不良组pT_(3)期、p N_(1)期、合并脉管瘤栓、肿瘤直径>3 cm患者所占比例高于预后良好组,差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,pT_(3)期、p N_(1)期、合并脉管瘤栓以及肿瘤直径>3 cm是影响食管鳞癌患者预后不良的危险因素(P<0.05)。结论pT2-3N0-1M0期食管鳞癌患者预后情况与pT和pN分期、合并脉管瘤栓情况、肿瘤直径密切相关。pT_(3)期、pN_(1)期、合并脉管瘤栓以及肿瘤直径>3 cm是影响食管鳞癌患者预后不良的危险因素。临床上对于存在上述危险因素的患者需予以重视,并早期进行干预,以降低预后不良的发生风险。

Objective To explore the postoperative prognosis and influencing factors of radical surgery in patients with pT2-3N0-1M0 stage thoracic esophageal squamous cell carcinoma.Methods A total of 138 patients with pT_(2-3)N_(0-1)M_(0)stage thoracic esophageal squamous cell carcinoma who underwent radical surgery at the First Affiliated Hospital of Xinjiang Medical University from January 2017 to November 2019 were selected as participants.Clinical and follow-up data of all patients were retrospectively collected and analyzed.Patients were required to undergo follow-up examinations 3-6 months after surgery within the first year,followed by examinations every 6-12 months,and then once a year after 3 years.All patients were followed up until December 2022.The local recurrence,lymph node metastasis,and survival prognosis of the patients were statistically analyzed,and logistic regression analysis was used to identify factors influencing the prognosis of patients with this condition.Results Among the 138 patients,129 patients completed the follow-up,with a follow-up rate of 93.48%.Within 3 years after surgery,78 patients demonstrated poor prognosis and 51 patients demonstrated good prognosis,resulting in a poor prognosis rate of 60.47%.No statistically significant differences were observed in age,gender composition,tumor location,postoperative adjuvant chemotherapy,and histological differentiation between patients with different prognoses(P>0.05).The proportion of patients with pT_(3)stage,pN_(1)stage,combined vascular tumor embolism,and tumor diameter>3 cm was significantly higher in patients with poor prognosis than in those with good prognosis(P<0.05).Logistic regression analysis showed that pT_(3)stage,pN_(1)stage,combined vascular tumor embolism,and tumor diameter>3 cm were risk factors for poor prognosis in patients with esophageal squamous cell carcinoma(P<0.05).Conclusion The prognosis of patients with pT2-3N0-1M0 stage thoracic esophageal squamous cell carcinoma is closely correlated with pT and pN staging,combined vascular tumor embolism,and tumor diameter.pT_(3)stage,pN_(1)stage,combined vascular tumor embolism,and tumor diameter>3 cm are risk factors for poor prognosis in patients with esophageal squamous cell carcinoma.Clinically,patients with these risk factors should be given attention and early intervention to reduce the risk of poor prognosis.