不同淋巴结清扫范围对Ⅲ期食管癌患者术后生存的影响

目的 探讨不同淋巴结清扫范围对Ⅲ期胸中段食管痛患者牛存率的影响,评价其安全性及可行性.方法 收集122例行完全性切除术的Ⅲ期胸中段食管癌患者的临床和随访资料,按照手术方式分为二野淋巴结清扫组(62例)和二野淋巴结清扫组(60例).采用寿命表法比较两组患者的牛存率,Kaplan-Meier法单因素分析全组患者凶病理分期、淋巴结清扫方式等不同而产生的生存差异,Cox多因素分析影响患者生存的主要因素.结果 两组患者的一般资料具有可比性.二野和三野淋巴结清扫组患者的并发症发生率分别为14.5%和15.0%,围手术期死亡率分别为1.6%和1.7%,差异均无统计学意义(均P＞0.05).二野淋巴结清扫组患者的术后1、3、5年生存率分别为78.2%、39.6%和14.5%,中位生存期为24个月;三野淋巴结清扫组患者的术后1、3、5年生存率分别为83.7%、42.4%和18.1%,中位生存期为31个月.在122例Ⅲ期胸中段食管癌患者中,术前体重下降不明显、术后病理分期为T3N1M0、仅有1个区域淋巴结转移且淋巴结转移数＜3枚、行三野淋巴结清扣术的患者预后较好(P＜0.05).多因素分析显示,T分期、N分期和淋巴结清扫方式是影响Ⅲ期胸中段食管癌患者预后的危险因素(P＜0.05).结论 三野淋巴结清扫能提高Ⅲ期胸中段食管癌患者的生存率,且并未增加并发症的发生率和围手术期死亡率,是安全可行的.

Impact of difierent extents of lymph node dissection on the survival in stage III esophageal caner patients

Objective To investigate the safety,feasibility and the impact of different extents of lymph node dissection on the survival in the patients with locally advanced thoracic esophageal carcinoma.Methods From January 2001 to December 2006.122 patients with locally advanced thoracic esophageal carcinoma underwent radical resection through cervical.thoracic,and abdominal incisions,and were randomly divided into two-field lymph node dissection group(Two-FD)and three-field lymph node dissection group(Three-FD).Life-table method was used to compare the difierence of survival rates between the two groups.Kaplan-Meier method was used to compare the cumulative survival time and median Survival time between the two groups.Multivariate analysis was performed using Cox model to identify the prognostic factors affecting the survival(a=0.05).Results There was no significant difference between the two groups in age,sex,and disease stage.Postoperative complication rate and perioperative mortality rate were 14.5%and 1.6%in the two.FD group versus 15.0%and 1.7%in the three-FD group,statistically without a significant difference(P＞0.05).The 1-,3-and 5-year survival rates were 78.2%,39.6%and 14.5% in the two-FD group.and 83.7%,42.4%and 18.1%in the three-FD group,respectively.The median survival time was 24.0 months in the two-FD group and 31.0 months in the three-FD group.Log-rank analysis showed that in the patients without preoperative weight loss,in T3NIMO stage,only single regional lymph node metastasis but＜3 in total.the three field lymph node dissection achieved a better prognosis (P＜0.05).Multivariate analysis using Cox model showed that T and N stages and lymph node dissection extent were still risk factors in patients with stage Ⅲ locally advanced thoracic esophageal carcinoma.Conclusion Compared with the two field lymph node dissection.the three field lymph node dissection is safe and feasible,and can improve the survival for a part of stage III esophageal cancer patients without increase in operative mortality and complications.