食管鳞癌环周切缘的临床意义分析

目的:分析食管鳞癌环周切缘情况与患者术后生存预后的关系,并探讨其与临床病理特征的相关性。方法:收集河北医科大学第四医院2017年10月至2019年3月行食管癌根治性切除术后的患者资料,所有患者临床资料完整,术后病理均为进展期鳞癌。采集并分析患者性别、年龄、T分期、N分期、肿瘤位置、病变长度、大体病理类型、脉管瘤栓、神经...     

Role of fibroblast growth factor in squamous cell carcinoma of the bladder: Prognostic biomarker and potential therapeutic target

BackgroundWe evaluated the association of fibroblast growth factor (FGF2) expression with pathologic features and clinical outcomes of squamous cell carcinoma (SCC) of the urinary bladder.MethodsImmunohistochemistry of FGF2 was performed on radical cystectomy specimens with pure SCC from 1997 to 2003. The relationship between FGF2 and pathologic parameters and oncological outcome was assessed.ResultsThe study included 151 patients with SCC (98 men) with a median age of 52 years (range: 36–74 y). Schistosomal infection was found in 81% of patients. Pathologic category was T2 and T3 in 88% of patients and the grade was low in>50%. Lymph node invasion and lymphovascular invasion were found in 30.5% and 16%. Altered FGF2 was associated with tumor grade (P = 0.014), lymph node invasion, and lymphovascular invasion (P = 0.042). Altered FGF2 was associated with both disease recurrence and cancer-specific mortality (P≤0.001) in Kaplan-Meier analyses and was an independent predictor of cancer recurrence (hazard ratio = 2.561, P = 0. 009) and cancer-specific mortality (hazard ratio = 2.679, P = 0. 033) in multivariate Cox regression analyses. Adding FGF2 to a model including standard clinicopathologic prognostics (pathologic T category, lymph node status, and grade) showed a significant improvement (6%) in accuracy of prediction poor oncological outcome.ConclusionsFGF2 overexpression is associated with aggressive pathologic features and worse outcomes after radical cystectomy for SCC, suggesting a good prognostic and possible therapeutic role.     

病理N1期胸段食管鳞癌根治术后复发转移危险因素分析

目的 探讨病理N1（pN1）期胸段食管鳞癌患者根治性切除术后复发转移的相关危险因素.方法 回顾性分析2004年1月至2010年12月间在上海市胸科医院接受根治性切除手术且术后病理证实为pN1期的95例胸段食管鳞癌患者的临床病理资料,采用Cox比例风险模型对其术后复发转移的独立危险因素进行多因素分析.结果 95例患者中术后3年内有52例（54.7％）出现复发转移,其中局域性复发42例（44.2％）,血行转移10例（10.5％）.多因素分析结果显示, 肿瘤浸润深度（RR=3.604,P=0.027）、淋巴结转移组数（RR=4.834,P=0.009）、淋巴结转移野数 （RR=5.689,P=0.003）及术后是否接受辅助化疗（RR=1.594,P=0.048）是影响pN1期胸段食管鳞癌患者术后复发转移的独立因素.结论 辅助化疗有助于降低pN1期胸段食管鳞癌患者术后复发转移的概率.对于术前临床评估为多组或多野淋巴结转移者,诱导治疗或可进一步提高治疗效果.     

术后替加氟辅助化疗对Ro切除的食管鳞癌患者生存率的影响

目的探讨替加氟用于辅助化疗对Ro切除食管鳞癌患者生存率的影响。方法收集汕头市中心医院肿瘤外科1987年1月至1996年12月食管鳞癌RO手术病例411例,其中单纯手术组74例,术后口服替加氟化疗组337例。化疗方案：替加氟800～1200mg／d．连续服用3周后休息一周,总剂量达到40g以上。结果单纯手术组5年生存率50．1％,替加氟术后化疗组5年生存率44．3％,两组患者5年生存率相比未见显著性差异（P=0．853）。另外,从不同性别、年龄、肿瘤部位、大体类型、分化程度、浸润深度、有无淋巴结转移和分期等亚组人群分析来看,单纯手术组与替加氟术后化疗组的生存率皆无显著性差异。Cox回归模型分析结果显示,年龄、分化程度、淋巴结转移是影响生存率的独立因素,而术后替加氟化疗对预后没有产生明显影响。结论替加氟用于术后辅助化疗没有明显提高RO切除的食管鳞癌患者的生存率。食管癌术后辅助化疗缺乏有效方案,有待今后进一步深入研究。     

Surgery for Unusual Histopathologic Variants of Esophageal Neoplasms: A Report of 23 Cases With Emphasis on Histopathologic Characteristics

Background: Adenocarcinoma and squamous cell carcinoma are the most frequent pathologic diagnoses with esophageal malignancy. Unusual pathologic variants are encountered in only 1% to 7% of patients, and therefore data evaluating the treatment and survival in this group of esophageal neoplasms are sparse.Methods: To get more insight into the unusual pathologic variants, patients were selected from our computer-assisted database containing data from 426 consecutive patients treated with esophageal resection or enucleation at our institute during 1993 to 2000.Results: Uncommon variants of esophageal neoplasms were encountered in 23 patients (5.3%). The following unusual histopathologic variants were seen: basaloid squamous cell carcinoma (n = 3), small-cell carcinoma (n = 1), leiomyoma (n = 5), gastrointestinal stromal tumor (n = 2), leiomyosarcoma (n = 1), adenosquamous carcinoma (n = 5), carcinosarcoma (n = 4), collision tumor (n = 1), and melanoma (n = 1). Presentation, histopathologic characteristics, treatment, and prognosis are described in reference to the existing literature.Conclusions: Survival data of the unusual pathologic variants seem to be comparable to those of the most frequently encountered neoplasms. Only in case of small-cell carcinoma does there seem to be a definite role for chemotherapy, especially in a multimodality treatment protocol.     

胸段食管鳞状细胞癌外科治疗与预后分析

目的 探讨胸段食管鳞状细胞癌切除术后生存率的影响因素.方法 回顾性分析1990年1月至1998年12月716例胸段食管鳞状细胞癌手术患者的临床病理资料,其中男性538例,女性178例;年龄24-78岁,中位年龄57岁.应用Kaplan-Meier法进行生存分析,组间比较用Logrank检验,采用COX模型进行多因素分析.结果 总的1、3、5和10年生存率分别为82.9%、44.3%、34.2%和25.7%.Ⅰ期、ⅡA期、ⅡB期和Ⅲ期患者的5年生存率分别为80.0%、51.2%、19.7%和13.3%.术后复发转移151例,占21.1%;其中ⅡA期、ⅡB期和Ⅲ期复发患者3年内复发率分别为84.2%、91.7%和90.O%.单因素分析表明性别、肿瘤浸润深度、淋巴结转移、病理分期、淋巴结转移区域数、组织分化、手术切缘和肿瘤复发均为预后影响因素.多因素分析显示肿瘤浸润深度、淋巴结转移、病理分期和肿瘤复发是食管癌预后的独立影响因素.结论 胸段食管鳞状细胞癌患者术后生存率的独立影响因素有肿瘤浸润深度、淋巴结转移、病理分期和肿瘤复发.手术是Ⅰ-ⅡA期食管癌的主要治疗方法,ⅡB-Ⅲ期食管癌应采用以手术为主的综合治疗.     

Basaloid-Squamous Carcinoma of the Esophagus Treated by Preoperative Chemotherapy: Report of Two Cases

Basaloid squamous carcinoma (BSC) of the esophagus has been associated with a poor outcome after surgery. We herein report two patients with esophageal BSC treated by preoperative chemotherapy. Patient 1 was a 55-year-old man who presented with a tumor of the middle esophagus diagnosed as BSC. He was treated by chemotherapy using a combination of 5-fluorouracil (5-FU: 750 mg/m², 1st–5th day, 24-h continuous infusion) and cisplatin (CDDP: 75 mg/m², 1st day, drip infusion per 2 h) before surgery, because of lymph node metastases of the mediastinum and around the left gastric artery. Even though the metastatic nodes were reduced and an esophagectomy was performed, the patient died of recurrence 12 months after chemotherapy. Patient 2 was a 57-year-old man who demonstrated BSC of the esophagus with direct invasion to the discending aorta, who was treated by preoperative chemotherapy using the same regimen as that of patient 1. The esophageal tumor was reduced, and a curative esophagectomy was performed. The patient is now alive without recurrence 38 months after chemotherapy. In conclusion, preoperative chemotherapy using a combination of 5-FU and CDDP may thus be an effective treatment for patients with advanced BSC of the esophagus. Received: September 19, 2001 / Accepted: May 7, 2002 RID="*" ID="*" Reprint requests to: N. Koide     

Expression and Prognostic Value of MG7-Ag in Patients With Surgically Resectable Esophageal Squamous Cell Carcinoma

Purpose MG7-Ag is a human gastric-carcinoma-associated antigen. The expression of MG7-Ag was found to increase gradually with the development and progression of gastric cancer. Moreover, a poorer prognosis was found in MG7-Ag positive gastric-carcinoma patients than in MG7-Ag negative patients. However, neither MG7-Ag expression nor its clinical significance has been previously examined in squamous cell carcinoma (SCC) of the esophagus. In this study, we examined the expression of MG7-Ag in esophageal squamous cell carcinomas to assess its value as a prognostic indicator. Methods The expression of MG7-Ag was detected in 112 cases of esophageal squamous cell carcinoma (SCC) by immunohistochemical analysis. The relation of MG7-Ag staining with various clinicopathological features was statistically analyzed. Results The staining of MG7-Ag was detected in SCC, while not in normal epithelial cells. In esophageal SCC, MG7-Ag was found significantly correlated with depth of invasion (P = .012), in T4, T3 carcinomas but not in T2, T1 carcinomas, lymph node metastases (P = .029), pathological stage (P = .005). Consistently, the survival rate tended to be statistically lower in patients with MG7-Ag positive SCCs than in MG7-Ag negative SCCs (P = .005). However, no significant difference was observed between MG7-expression and patient age, sex, tumor location, differentiation, distant metastasis, and lymphatic invasion. Conclusion MG7-Ag might play a positive role in the process of carcinogenesis and progression of esophageal SCC, and it could be considered as one valuable prognostic indicator in esophageal SCC.     

胸段食管鳞癌患者的喉返神经旁淋巴结转移特点

目的探究胸段食管鳞癌患者的喉返神经旁淋巴结转移特点。 方法回顾性分析福建协和医院胸外科2012年1月至2015年12月间收治的行胸腹腔镜联合食管癌切除术的294例胸段食管鳞癌患者的喉返神经旁淋巴结清扫及转移情况,并分析喉返神经旁淋巴结转移特点。 结果294例行喉返神经旁淋巴结清扫的患者中,有88例患者有喉返神经旁淋巴结转移,转移率为29.93%;共清扫喉返神经旁淋巴结1 899枚,转移淋巴结145枚,转移度为7.64%。胸段食管鳞癌患者左、右喉返神经旁淋巴结转移与肿瘤浸润深度、分化程度、脉管瘤栓均有显著相关性(P<0.05),但与性别、年龄、肿瘤部位无显著相关性(P>0.05)。 结论胸段食管鳞癌患者易发生喉返神经旁淋巴结转移。对于肿瘤浸润程度大、分化程度差、有脉管瘤栓的胸段食管鳞癌患者,应重视左、右两侧喉返神经旁淋巴结清扫。     

Impact of subcarinal dissection on short-term outcome and survival following esophagectomy

Background

The purpose of this study was to investigate the impact of subcarinal dissection on short-term outcomes and survival after esophagectomy in patients with thoracic esophageal squamous cell carcinoma.

Methods

Patients without subcarinal dissection were matched randomly to patients with subcarinal dissection in a 1:1 ratio according to 5 baseline variables (gender, pathologic stage, tumor location, histologic grade, and surgical approach) that may have major impacts on short-term outcomes and survival after esophagectomy in patients with thoracic esophageal squamous cell carcinoma. Preoperative clinical characteristics, short-term outcomes, and survival after esophagectomy of the 2 groups were compared.

Results

There were 128 patients included in each group. Blood loss, postoperative pleural drainage volume, and the incidences of postoperative complications and pulmonary complications in the nondissection group were significantly less than in the dissection group. The comparison of overall survival curves and disease-free survival curves between the 2 groups showed no significant difference (P > .05).

Conclusions

Subcarinal dissection might be futile for patients with thoracic esophageal squamous cell carcinoma.     

胆囊腺鳞癌和鳞癌与胆囊腺癌的临床对比研究

目的 探讨胆囊腺鳞癌和鳞癌的临床特点.方法 回顾性分析112例胆囊癌患者的临床资料,将其中11例胆囊腺鳞癌和鳞癌的临床特点和预后与同期收治的101例胆囊腺癌进行比较.结果 腺鳞癌/鳞癌组与腺癌组的肿瘤浸润分期为13或T4的比例分别为100%和53%,两组的差异有统计学意义(X2=7.013,P=0.008).腺鳞癌/鳞癌与进展期腺癌(T3或T4期)的远处转移发生率分别为0和35%,差异有统计学意义(X2=3.900,P=0.048),两组的淋巴结转移率为82%和87%(X2=0.000,P=1.000).腺鳞癌/鳞癌组和进展期的腺癌组的胃肠道侵犯发生率分别为45%和15%,差异无统计学意义(X2=3.618,P=0.054).两组的中位生存期分别为5个月和4个月,生存差异无统计学意义(X2=0.359,P=0.549).结论 胆囊腺鳞癌和鳞癌的局部侵袭性强,而远处转移率低.淋巴结转移情况与腺癌相似.     

Multimodality treatments with endoscopic mucosal resection of esophageal squamous cell carcinoma with submucosal invasion

Background and study aims: A standard treatment for esophageal squamous cell carcinoma (SCC) with submucosal invasion is considered to be radical resection at present. In this study, we evaluated the efficacy of multimodality treatments with endoscopic mucosal resection (EMR) of esophageal SCC with submucosal invasion. Method: Eighteen cases of SCC with submucosal invasion were treated with EMR. Lymphatic invasion was found in 11 cases (67%), and there were no cases of blood vessel invasion. EMR was performed prior to any other treatment. Chemotherapy and/or radiotherapy were added if indicated by the histopathological features. Results: There were no cases of local recurrence. Lymph-node recurrence was detected in 1 case treated with EMR alone. There were no cases of cancer death. The overall survival rate was 83% in all patients.Conclusions: Multimodality treatments with EMR were effective in treating esophageal SCC with submucosal invasion.     

Large cell neuroendocrine carcinoma of the lung: an aggressive disease potentially treatable with surgery

BACKGROUND: Assessment of clinical and pathologic features of large cell neuroendocrine carcinoma to confirm its specificity in the setting of high grade neuroendocrine pulmonary tumors. METHODS: From 1989 to 2001, 123 patients with a neuroendocrine carcinoma were surgically treated in a curative intent at a single institution. According to the 1999 World Health Organization classification, 20 patients were reviewed as having a large cell neuroendocrine carcinoma. Clinical data as well as detailed pathologic analysis and survival were collected. RESULTS: There were 18 men and 2 women. The median age was 62 years. Four patients had a preoperative diagnosis of large cell neuroendocrine carcinoma. The resections consisted of 14 lobectomies and 6 pneumonectomies. There was no operative death. Complications occurred in 7 patients (35%). Four patients had a stage I of the disease, 4 had stage II, 9 had stage III, and 3 had stage IV. At follow-up (median, 46 months), 13 patients died from general recurrence and 7 patients were still alive. Median time to progression was 9 months (range, 1 to 54 months). The 5-year survival rate was 36% (median, 49 months) and it seemed to be negatively influenced by the disease stage (54% for stage I-II vs 25% for stage III-IV; p = 0.07), the presence of metastatic lymph node (45% for N0/N1 vs 17% for N2; p = 0.12), or vessel invasion (66 vs 25%; p = 0.18). CONCLUSIONS: Large cell neuroendocrine carcinoma predominantly occurred in men. An accurate tissue diagnosis was rarely obtained preoperatively. Although overall survival after resection was substantial, large cell neuroendocrine carcinoma frequently showed pathologic features of occult metastatic disease, such as lymph node or vessel invasion, or both.     

Lip carcinoma: clinical presentation,surgical treatment,and outcome: a series of 108 cases from Denmark

Objective: Lip carcinomas are among the most common malignant tumours of the head and neck region but reports on the course and outcome of this disease are mainly based on Mediterranean, South American, and Oceanian populations. The aim of the study was to describe the treatment and outcome of patients with lip carcinoma at a Danish department of plastic surgery.

Method: We conducted a single institution retrospective cohort study including patients with primary cancer of the lips including squamous cell (SCC), basal cell (BCC), and basosquamous carcinomas (BSC) in a 5-year period.

Results: We included 108 consecutive patients. Median age was 72 years (range 28 -98) and 58% were male. Seventy patients (65%) were diagnosed with SCC, 36 (33%) BCC, and 2 (2%) BSC. The majority of lesions were stage T1 (84%) and T2 (11%). An unexpected total of 35 (32%) patients experienced wound healing problems; whereof 19 (54%) classified as mild (not demanding treatment), 10 (29%) as moderate (non-functional surgical corrections or medical treatment of infection needed) and 6 (17%) experienced severe dehiscence (requiring surgical intervention for functional improvement). Total defect size ≥20?mm and full thickness excision was directly correlated to the risk of early postoperative complications (p-value: 0.03 and 0.04). Three patients (2/36 with BCC; 6% and 1/70 with SCC; 1%) developed local recurrence and five patients with SCC (5/70; 7%) developed regional lymph node metastases. One patient (1%) died from metastatic SCC.

Conclusion: This study confirms that lip carcinoma is associated with a risk of recurrence and mortality. However, the risk of wound complications is notable compared to other series.     

Clinicopathologic features of peripheral squamous cell carcinoma of the lung

Background

The clinicopathologic features are still unknown in peripheral squamous cell carcinoma of the lung, unlike centrally located carcinomas. In this retrospective study, we investigated the clinicopathologic characteristics of patients with peripheral squamous cell carcinomas.

Methods

Of 1,381 primary lung carcinomas surgically resected at the National Cancer Center Hospital, Tokyo, from 1995 through 2001, 70 (5.1%) peripheral squamous cell carcinomas of 3.0 cm or less in diameter were studied retrospectively in terms of clinicopathologic characteristics such as age, sex, past history, smoking, tumor size, mode of operation, extent of lymph node dissection, pathologic lymph node status, mode of recurrence, and cause of death.

Results

These patients ranged in age from 49 to 82 years, with a mean age of 69.2 years. Thirty-nine patients (56%) were at increased risk preoperatively. The incidence of lymph node metastasis was 25%, and larger tumors tended to be associated with a higher prevalence, although this difference was not significant (p = 0.12). None of the patients with N2 disease had skipping metastasis. Recurrence was observed in 13 patients (19%). There was no significant correlation between recurrence and the extent of lymphadenectomy or the mode of operation. The 5-year overall and disease-specific survival rates were 73.4% and 85.9%, respectively. The cause of death was recurrence in 53% and other disease in 47%.

Conclusions

We propose that mediastinal hilar lymphadenectomy should be routinely conducted as a curative operation for low-risk patients with small peripheral squamous cell carcinoma. We further propose that for patients who may have difficulty tolerating this procedure, pathologic examination of intraoperative frozen sections from the hilar node could be useful for planning a surgical strategy.     

An audit of surgical outcomes of esophageal squamous cell carcinoma.

OBJECTIVE: Esophageal squamous cell carcinoma and adenocarcinoma were increasingly recognized as two entities with different biologic behaviors and prognosis. Surgical risks and oncologic benefits of transthoracic and transhiatal esophagectomy for esophageal squamous cell carcinoma patients are not confessed. METHODS: Between 1994 and 2005, 216 esophageal squamous cell carcinoma patients underwent esophagectomy were enrolled and analyzed retrospectively. RESULTS: One hundred sixty-six patients underwent transthoracic esophagectomy and 50 patients underwent transhiatal esophagectomy. The overall hospital mortality and postoperative complication rates were 9.7 and 49%, respectively. The amount of intra-operative blood loss or transfusion, postoperative complication rate, lengths of hospital stay and hospital mortality rate were not significantly different between both groups. However, shorter operative time was noticed in transhiatal group (p<0.001). The overall 5-year survival rate was 16.8%. ESCC patients underwent either transthoracic or transhiatal esophagectomy had comparable long-term survival. The pTNM stage was independent prognostic factor for patients underwent transthoracic esophagectomy. However, location of tumor (p=0.009) and pathologic tumor length (p=0.012) were predictors of prognosis for patients underwent transhiatal esophagectomy. CONCLUSIONS: For esophageal squamous cell carcinoma patients, no significant differences in postoperative mortality or morbidity rates were observed between transthoracic and transhiatal esophagectomy. However, traditional pTNM staging system might underestimate the severity of esophageal squamous cell carcinoma patients who underwent transhiatal esophagectomy. The information of dissimilar prognostic factors for transhiatal or transthoracic esophagectomies will be helpful in tailoring more individualized adjuvant therapy to optimize esophageal squamous cell carcinoma patient's outcome.     

Prognostic value of recurrence pattern in locally advanced esophageal squamous cell carcinoma: Results from the phase III trial NEOCRTEC5010

ObjectivesThe prognosis of patients with locally advanced esophageal squamous cell carcinoma with different recurrence backgrounds is highly heterogeneous. This study aims to explore the effects of recurrence patterns on prognosis.MethodsThe phase III, multicenter, prospective NEOCRTEC5010 trial enrolled 451 patients with stage IIB-III esophageal squamous cell carcinoma randomly assigned to neoadjuvant chemoradiotherapy combined with surgery (NCRT group) or surgery alone (S group) and followed them long-term. We investigated the effects of recurrence patterns on survival in patients undergoing radical esophagectomy.ResultsIn total, 353 patients were included in the study. The 5-year overall survival of patients with different recurrence patterns was significantly different: recurrence versus recurrence-free (17.8% vs 89.2%; P < .001), early recurrence versus late recurrence (4.6% vs 51.2%; P < .001), and distant metastasis versus locoregional recurrence (17.0% vs 20.0%; P = .666). Patients with early recurrence had significantly shorter survival after recurrence than those with late recurrence (hazard ratio, 1.541; 95% confidence interval, 1.047-2.268, P = .028). There was no significant difference in postrecurrence survival between patients with distant metastasis and locoregional recurrence (hazard ratio, 1.181; 95% confidence interval, 0.804-1.734; P = .396). Multivariate logistic analysis showed that pN1 stage, lymph node dissection <20, and lack of response to NCRT were independent risk factors for postoperative early recurrence. Multivariate Cox regression suggested that NCRT, age ≥60 years, early recurrence, and the pN1 stage were independent risk factors for shortened survival after recurrence.ConclusionsPrerecurrence primary tumor stage is inaccurate in predicting postrecurrence survival. In contrast, recurrence patterns can guide follow-up while also predicting postrecurrence survival. NCRT prolongs disease-free survival but is associated with a worse prognosis in patients with recurrence, especially early recurrence.     

Anterior tongue cancer: age is not a predictor of outcome and should not alter treatment

Background: Mucosal head and neck cancers usually occur in older males after years of smoking and alcohol abuse. Despite this, approximately 5% of cases occur in young adults. The aetiology remains unclear and the anterior tongue is a prevalent site. Prognosis has been reported as worse in young patients and some have proposed a more aggressive treatment approach. Methods: Patients diagnosed with previously untreated anterior tongue squamous cell carcinoma and treated with curative intent were identified. Retrospective and prospective data were collected. Univariate and multivariate analyses were undertaken using Cox regression analysis. The outcome of patients treated with anterior tongue cancer using a cut‐off age of 40 years was compared. Results: Between 1980 and 2000, 106 males and 58 females with anterior tongue squamous cell carcinoma were treated at Westmead Hospital. Median follow up was 47 months (6?210 months). Twenty‐two patients (13.4%) were aged ≤40 years. Other than age, patient demographics, TNM stage and treatment approach were similar between the two groups. Eighty‐one per cent had either a T1 or T2 primary. In total, 139 patients (84.8%) had surgery or surgery and radiotherapy. A total of 56 (34%) patients experienced a recurrent event, with nodal recurrence occurring most often as the first site (n = 33, 59%). Young patients had a higher recurrence rate (45.5% vs 32.4%; P = 0.23). Relapse‐free survival at 5 years was 62% versus 81% (P = 0.27). Overall survival at 5 years was 65% versus 67% (P = 0.74). Conclusions: In keeping with recently published evidence, young age at diagnosis with anterior tongue cancer did not portend worse outcome. There is therefore currently no strong evidence to support a different treatment approach in young patients.     

青年人食管癌临床病理特征及预后

目的 探讨青年人与中老年人食管癌的临床病理特征及预后的差异.方法 回顾性分析1990年1月至1998年12月间在中山大学肿瘤防治中心接受手术治疗的716例食管鳞状细胞癌患者的临床资料,对其中117例45岁以下 （青年组）和599例大于45岁（中老年组）患者的临床病理特征及预后进行对比分析.结果 除肿瘤分期外,青年组与中老年组临床病理特征的差异均无统计学意义（均P＞0.05）.青年组Ⅲ期患者所占比例为47.9％（56/117）,明显高于中老年组的33.6％（201/599,P=0.010）.但青年组与中老年组患者的预后差异并无统计学意义（5年生存率：36.0％比33.8％,10年生存率：29.2％比25.0％,P=0.418）.多因素预后分析显示,患者年龄不是食管癌的独立预后因素 （P=0.160,RR=1.187,95％CI：0.935～1.506）.结论 尽管青年人食管癌的病理分期较晚,但其预后与中老年人并无明显差异.     

Postoperative irradiation for squamous cell carcinoma of the oral cavity: 35-year experience

BACKGROUND: The purpose of this study was to analyze factors influencing outcome in patients who received postoperative irradiation for advanced squamous cell carcinoma of the oral cavity. METHODS: Between October 1964 and November 2000, 226 patients with 230 previously untreated primary invasive squamous cell carcinomas of the oral cavity were treated postoperatively with continuous-course external beam irradiation. All patients had a minimum follow-up of 2 years (analysis, November 2002). No patient was lost to follow-up. RESULTS: The 5-year actuarial rates of locoregional control by pathologic American Joint Committee on Cancer stage were: stage I, 100%; stage II, 84%; stage III, 78%; and stage IV, 66%. Recurrence of cancer above the clavicles developed in 55 patients (24%). In multivariate analysis of locoregional control, positive margins, vascular invasion, perineural invasion, extracapsular extension, and T classification remained significant. CONCLUSIONS: This article provides additional data defining relatively favorable and unfavorable groups of patients in the postoperative setting. Dose recommendations are re-examined and selectively increased for high-risk patients.