影响胸段食管鳞癌切除术预后的因素

目的探讨影响胸段食管癌患者切除手术的预后因素。方法对217例经颈、胸、腹“3区域”淋巴结清除根治术患者,选择对食管癌切除术预后可能产生影响的9个特征性临床病理因素进行回顾性预后分析。结果全组淋巴结清除术后1、3、5年生存率分别为82.6%、59.8%、和48.8%。影响预后的单因素分析表明肿瘤浸润深度、分化程度、临床分期、淋巴结转移个数、淋巴结转移区域数和年龄对预后有影响。影响预后的Cox模型多因素分析表明,肿瘤浸润深度、分化程度、淋巴结转移区域数和肿瘤部位对预后有显著的影响。随着食管癌淋巴结转移区域数的增加,患者生存率逐渐下降(P=0.0284)。结论淋巴结转移尤其是淋巴结转移区域数是胸段食管癌切除术后影响患者预后的主要因素;因此,胸段食管癌尤其是胸上、中段食管癌在条件具备时应施行“3区域”淋巴结清扫术。

Analysis of prognostic factors in patients with thoracic esophageal squamous carcinoma after radical resection

Objective To explore the prognostic factors in patients with thoracic esophageal carcinoma after curative resection. Methods A retrospective study was performed on the clinical data of 217 patients who underwent radical operation through three field lymphadenectomy. Nine possible factors influencing survival rate were studied. Univariate and multivariate analysis of these factors were performed by Cox proportional hazard model. Results The 1 year,3 year and 5 year survival rates of all patients were 82.6%,59.8%and 38.8%respectively. The univariate analysis showed that depth of tumor invasion,degree of tumor differentiation,clinic stage,number of metastatic lymph nodes,number of lymph nodes metastatic field and age were prognostic factors,but sex,length of the tumor and tumor location were not. According to multivariate analysis,depth of tumor invasion,tumor differentiation,number of lymph nodes metastatic field and tumor location were independent prognostic factors. With the number of lymph nodes metastatic field increasing,the survival rate of patients decreased gradually(P=0.0284). Conclusions Lymph nodes matastasis especially the number of lymph nodes metastatic field is one of key factors affecting the prognosis of patients. The patients with thoracic esophageal carcinoma should be given radical operation through three field lymphadenectomy as routinely as possible when conditions permit,or comprehensive therapy should be strengthened,to elevate the 5 year survival rate.