摘要
目的 回顾性分析Ⅲ期胸段食管癌术后患者的预后及其影响因素。方法 收集504例Ⅲ期胸段食管癌患者的临床资料，其中男388例，女116例，中位年龄60岁。胸上、中、下段食管癌分别为44、334和126例。采用两野和三野手术者分别为476和28例；术后病理为Ⅲa期292例，Ⅲb期128例，Ⅲc期84例。单纯手术137例，术后化疗264例，放疗64例，放化疗39例。结果 全组患者术后1、3、5年生存率分别为73.0%、34.4%和26.7%，中位生存期为22个月。单因素分析结果显示，手术方式、肿瘤位置、N分期、TNM分期和术后辅助治疗与患者的生存时间均有关（均P〈0.05）。Cox多因素分析结果显示，TNM分期和术后辅助治疗均为影响患者生存时间的独立危险因素（均P〈0.05）。胸中段食管癌和中高分化鳞癌术后辅助治疗患者的生存率高于单纯手术者（P〈0.05）。全组1、3、5年无进展生存率分别为57.3%、32.0%和27.0%。单因素分析结果显示，肿瘤位置、病理残端、N分期、临床分期和术后辅助治疗与患者的无进展生存时间均有关（均P〈0.05）。Cox多因素分析结果显示，肿瘤位置、病理残端、TNM分期和术后辅助治疗均为影响患者的无进展生存时间的独立危险因素（均P〈0.05）。术中重度粘连或残端阳性者的无进展生存率明显降低（P〈0.05）。结论 两野术后Ⅲ期食管癌患者的预后不理想，临床分期早预后好，临床分期晚预后差。术后辅助治疗者预后较好（尤其是胸中段食管癌和中高分化鳞癌），单纯手术者预后较差。肿瘤位置也影响患者的预后，胸中段食管癌预后较差，术中重度粘连或残端阳性者，术后肿瘤进展的概率增加。
Objective To retrospectively analyze the prognosis and its related factor in stage m thoracic esophageal carcinoma after surgery. Methods 504 patients with stage Ill thoracic esophageal cancer after resection were included in this study. There were 388 males and 116 females. The median age was 60 years. 476 cases were treated with two-field and 28 with three-field lymphadenectomy. There were 44 cases of upper-, 334 of middle-, and 126 of lower-thoracic esophageal cancer. There were 292 patients with stage Ⅲa, 128 with stage Ⅲ b and 84 with stage Ⅲ c esophageal cancer. 137 patients were treated with surgery alone, 264 had postoperative chemotherapy （CT） , 64 had radiotherapy （RT） and 39 had CT plus RT. Results The follow-up was ended on September 31, 2014. The 1-, 3-, and 5-year overall survival （OS） rates and median survival were 73.0%, 34.4%, 26.7% and 22 months, respectively. Univariate analysis showed that mode of surgery, site of lesion, N and TNM stages, and postoperative adjuvant therapy were significantly associated with OS （P〈0.05 for all）. Multivariate analysis showed that TNM and adjuvant therapy were independent factors for OS （ P〈 0.05 for both）. The 1-, 3-, 5-years progression-free survival （PFS） rates of patients undergoing postoperative adjuvant therapy were 57.3%, 32.0% and 27.0%, respectively, higher than those of the patients treated by surgery alone （P〈0.05）. Further analysis showed that postoperative chemotherapy and/or radiotherapy could mainly improve OS in the patients with cancer in the upper- or middle-thoracic segment and well- or moderately differentiated squamous cell carcimoma （P〈0.05）. Univariate analysis showed that site of lesion, N and TNM stage, R0/R1 and adjuvant therapy were significantly related to PFS （ P〈 0.05 ）. Multivariate analysis showed that site of lesion, RO/R1 resection, TNM stage and postoperative adjuvant therapy were independent factors for PFS （P〈0.05 for all）. Patients with severe adhesion at surgery or R1 resection had a lower PFS rate （P〈 0.05 ）. Conclusions The prognosis of stage Ⅲ esophageal carcinoma after two-field surgery is poor. TNM stage and postoperative adjuvant therapy are independent factors for OS and PFS. Postoperative chemotherapy and/or radiotherapy can improve OS and PFS. Site of lesion is also associated with prognosis. The risk of disease progression could be increased in patients with severe adhesion at surgery or R1 resection.
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2016年第7期530-537,共8页
Chinese Journal of Oncology
基金
河北省医学科学研究重点课题（20150759）
关键词
食管肿瘤
外科手术
放射疗法
计算机辅助
抗肿瘤联合化疗方案
预后
Esophageal neoplasms
Surgical procedures, operative
Radiotherapy,computer-assisted
Antineoplastic combined chemotherapy protocols
Prognosis
