213例ⅢB期食管胃结合部腺癌患者术后5年随访及预后分析

Prognosis and 5-year Follow-up of 213 Cases of StageⅢB Adenocarcinoma Patient of Esophagogastric Junction Treated by Surgery

目的探讨Ⅲb期食管胃结合部腺癌(adenocarcinoma of esophagogastric junction,AEG)的外科治疗效果及影响预后的相关因素。方法回顾性分析了2006年3月至2007年2月在河北医科大学第四医院胸外科接受治疗的213例ⅢB期AEG患者的临床病例资料,对患者进行了5年的随访,采用寿命表法计算患者的生存率,Kaplan-Meier法进行预后生存分析,Cox比例风险模型进行多因素分析。结果本组根治性切除术207例、扩大性切除术3例、姑息性切除术3例。总体1年生存率为83%,3年生存率为46%,5年生存率为32%。单因素分析显示:性别、手术方式、残端是否阳性及术后化疗是影响预后的主要因素。多因素分析显示:性别(P=0.016)、手术方式(P=0.025)、术后化疗(P=0.001)及残端是否阳性(P=0.002)是影响预后的独立危险因素。结论ⅢB期食管胃结合部腺癌的预后较差,性别、手术方式、残端是否阳性及术后化疗是独立性预后因素。综合治疗仍是提高ⅢB期食管胃结合部腺癌患者治疗效果的主要途径。

Objective To analyze the therapeutic effect and prognosis-related factors of the patients with stageⅢB adenocarcinoma of esophagogastric junction(AEG) treated by surgery. Methods We analyzed retrospectively the clinicopathologic data of 213 AEG patients treated in the Fourth Hospital of Hebei Medical University from March 2006 to February 2007. A 5-years follow-up was conducted for this cohort of patients. Survival analysis was performed by Kaplan-Meier method and survival rate was obtained by life table method. Multivariate analysis was applied using Cox proportional hazard model. Results Radical surgery was performed in 207 patients; enlargement surgery was done in 3 patients, whereas the palliative operation was taken in 3 cases. The overall 1-, 3- and 5-year survival rates of this cohort were 80.0%, 46.0% and 32.0% respectively. These factors as follows were shown to be related to patients’ survival by univariate analysis: gender, surgical type, surgical margin and adjuvant chemotherapy. Multivariate analysis demonstrated that gender(P=0.016), surgical type(P=0.025), surgical margin(P=0.002) and adjuvant chemotherapy(P=0.001)were regarded as independent prognostic factors. Conclusion The prognosis of stageⅢB AEG patients remains poor. Gender, surgical type, surgical margin and adjuvant chemotherapy are regarded as independent prognostic factors. Comprehensive therapy remains vital to enhance the treatment efficacy.