支架置入术后晚期食管癌患者预后影响因素的Cox回归分析

Cox Regression Analysis of the Prognostic Factors of Unresectable Esophageal Carcinoma after Stenting

背景和目的:支架置入术治疗晚期食管癌的预后受多种因素影响,哪些是主要因素,目前尚不明了。本文分析影响食管支架置入术治疗晚期食管癌患者的预后因素,探索晚期食管癌姑息治疗的合理方案。方法:对1997～2001年连续收治符合入组条件的、经支架置入术治疗的晚期食管癌患者102例,以性别、年龄、肿瘤部位、肿瘤长度、食管狭窄程度、肿瘤病理类型、肿瘤细胞分化程度、临床分期(T、N、M)、术前治疗、术后治疗(放疗和/或化疗)等12个因素作为分析因子,应用Cox回归模型分析影响预后的因素,应用寿命表法计算生存率。结果:全组支架置入成功率98.3%。所有患者吞咽功能明显改善(P=0.000)、生活质量评分(KPS评分)明显提高(P=0.000),并发症发生率43.1%(44/102)。术后3、6、9、12个月生存率分别是67.53%、40.59%、27.43%、18.65%。Cox回归分析结果:影响预后有统计学意义的因子是原发肿瘤浸润程度(P=0.0410)和远处转移情况(P=0.006),两者的OR值分别为1.750(95%CI,0.996～3.074)和1.527(95%CI,1.126～2.069),支架置入术后放疗或/和化疗对生存期的影响无统计学意义。结论:影响支架置入术后患者生存期的因素,主要是原发肿瘤的浸润情况及远处转移情况;支架置入术后进一步放疗和/或化疗不能延长患者生存期。

BACKGROUND &OBJECTIVE:There are many factors affect the prog nosis of the patients with unres ectable esophag eal carcinoma who underwent intubation,however,it i s unclear which ones are main causes s o far.This study was desig ned to analyze th e prog nostic factors of unresectabl e esophag eal carcinoma after stentin g in order to find the reasonable moda lities of palliative therapy.METHODS :Consecutive 102patients with unres ectable esophag eal carcinoma who were elig i ble for inclusion criteria were anal yzed after stenting .Twelve factors including g ender,ag e,tumor site,tumor leng t h,stricture deg ree in diameter,patho log ic type,g rade of cell differentiation,clinical tumor stag e (T,N,M),pre-stenting therapy and post-ste nting therapy (radiotherapy and /or chemotherapy )were used for Cox reg ression model analysis.The survival rate was calc ulated by life table.RESULTS :The technical success rate of stenting w as 98.3%.There were sig nificant improvement on the g rade of swallowi ng function(P=0.000)and quality of life(KPS scores ,P=0.000).The incidence rate of complications was 43.1%(44/102).The survival rates of 3,6,9,12mont hs were 67.53%,40.59%,27.43%,and 18.65%,respectively.T he results of Cox reg ression showed t hat invasion deg ree of primary tumor (T,P=0.0410)and distal metastasis(M,P=0.006)were the statistically sig nificant prog nostic factors.The odds ratio(OR T )was 1.750(95%CI ,0.996-3.074)on T stag e of primary carcinoma ,OR M was 1.527(95%CI ,1.126-2.069)on M stag e.There was no statistical sig nificance in the survival of the p atients affected by radiotherapy an d /or chemotherapy after intubation.CONCLUSION:T stag e and M stag e are the major prog nostic factors affecting the survival of patients with unrese ctable esophag eal carcinoma after stentin g .There is no benefit for survival of patients treated with radiotherapy and /or ch emotherapy after intubation.