胸段食管鳞状细胞癌术后淋巴结转移患者预后影响因素及治疗策略分析

目的:探讨胸段食管鳞状细胞癌术后淋巴结(lymph node,LN)转移患者预后影响因素及治疗策略.方法:回顾性分析我院2008年1月-2014年3月收治的胸段食管鳞状细胞癌根治术后LN转移患者共411例临床资料,对预后影响因素进行单因素和多因素分析,进一步采用倾向性得分匹配法配对后确定最佳治疗策略.结果:入选患者随访...

Analysis of prognostic influencing factors and treatment strategies of patients with LN metastasis after thoracic esophageal squamous cell carcinoma resection

Objective:To investigate the prognostic influencing factors and treatment strategies of patients with LN metastasis after thoracic esophageal squamous cell carcinoma resection.Methods:Clinical data of 411 patients with LN metastasis after thoracic esophageal squamous cell carcinoma resection were retrospectively chosen in the period from January 2008 to March 2014 in our hospital.Univariate and multivariate analysis of prognostic factors were carried out,and the optimal treatment strategy was determined by matching the prognostic factors with propensity score matching method.Results:The cumulative overall survival rates for 1,3 and 5 years were respectively 81.09%,40.66% and 28.14%.The cumulative progression-free survival rates for 1,3 and 5 years were respectively 70.54%,41.20%,33.27%.The median total survival time and progression-free survival time were respectively 27.0 months ［(24.5~31.0) months］,23.0 months ［(21.0~27.0) months］.Univariate analysis showed that gender,age,tumor length,T stage,N stage and treatment strategy were related to the overall survival time of patients with LN metastasis after operation（P<0.05）.Gender,T stage,N stage and treatment strategy were related to the progression-free survival time of patients with LN metastasis after operation（P<0.05）.Multivariate analysis showed that gender,age，tumor location,T stage,N stage and treatment strategy were independent influencing factors for overall survival time of patients with LN metastasis after operation（P<0.05）.The gender,tumor location,T stage and N stage were independent influencing factors for progression-free survival time of patients with LN metastasis after operation（P<0.05）.Analysis results for including the above-mentioned factors of total survival and progression-free survival into the propensity score matching matching pair showed that N stage and treatment strategy were independent influencing factors of total survival time and progression-free survival time of patients with LN metastasis after operation（P＜0.05）.Propensity score matching pair analysis showed that the overall survival rate of patients receiving post-operative adjuvant radiotherapy and post-operative adjuvant chemotherapy were significantly higher than simple operation（P＜0.05）.The overall survival rate and progression-free survival rate of patients with adjuvant radiotherapy and chemotherapy after operation were significantly higher than simple operation,adjuvant radiotherapy after operation and adjuvant chemotherapy after operation（P＜0.05）.The overall survival rate and progression-free survival rate of patients with stage N1 were significantly higher than stage N2 and N3（P＜0.05）.Conclusion:The number of lymph node metastases and treatment strategies are closely related to the long-term prognosis of patients with LN metastasis after radical resection of thoracic esophageal squamous cell carcinoma.Postoperative radiotherapy and chemotherapy should be the preferred adjuvant regimen in order to further improve the survival benefits.