食管癌高、低发区食管鳞癌患者生存及其影响因素分析

目的探讨食管癌高、低发区食管鳞癌患者的生存状况及其影响因素。方法收集38741例经病理学证实为食管鳞癌患者的资料,其中,高发区患者23273例(60.1%),低发区15468例(39.9%)。所有患者均行食管癌根治术。运用卡方检验分析不同临床病理特征患者的组间差异,Kaplan-Meier法绘制不同临床病理特征患者的生存曲线并用Logrank进行检验。多因素Cox比例风险回归模型法分析影响生存的主要因素。结果低发区男性患者所占比例高于高发区(P<0.001),低发区诊断年龄≥50岁食管癌患者所占比例高于高发区(P<0.001)。高发区食管鳞癌患者的整体生存优于低发区患者(P<0.001)。Cox比例风险回归模型综合分析结果表明:高低发区、性别、确诊年龄、肿瘤部位、分化程度、TNM分期和肿瘤家族史均是影响食管鳞癌患者生存的独立因素。结论高发区食管鳞癌患者整体生存优于低发区;低发区是食管鳞癌患者预后差的独立危险因素。

Comparison of Survival Status and Related Risk Factors of Esophageal Squamous Cell Carcinoma Patients Between High- and Low-incidence Areas of ESCC

Objective To compare the survival condition and related risk factors of the patients with ESCC between high-incidence area (HIA) and low-incidence area (LIA) of ESCC. Methods We collected the data of 38741 ESCC patients confirmed by pathology, among which, 23273 cases (60.1%) were from HIA and 15468 cases (39.9%) were from LIA. All patients underwent radical esophagectomy. Chi-square test was used to analyze the differences between groups of the patients with different clinicopathological characteristics, and Kaplan-Meier method was used to draw and Log rank test was used to assess the survival curves of the patients. Cox proportional hazards model was used to analyze the main influencing factors of survival. Results The proportion of male patients in LIA was higher than that in HIA (P<0.001). The proportion of patients ≥50 years old in LIA was also higher than that in HIA (P<0.001). ESCC patients in HIA had obviously better overall survival than patients in LIA (P<0.001). HIA/LIA, gender, age at diagnosis, tumor location, differentiation, TNM stage and family history were independent factors for the survival of ESCC patients. Conclusion ESCC patients in HIA have obviously higher overall survival than those in LIA. LIA is an independent risk factor for poor survival of ESCC patients.