食管鳞癌患者根治性手术后早期死亡的危险因素分析

目的]分析导致食管鳞癌患者手术后早期死亡的危险因素。方法]回顾性分析确诊为食管鳞癌并行根治性手术切除的249例患者的临床资料,随访5年。采用χ2或Fisher精确概率法、t检验等分析所有可能导致患者在术后1年内死亡的因素。单因素及多因素Cox回归模型分析确定影响患者早期死亡最主要的危险因素,使用Kaplan-Meier法中的log-rank法对患者生存率进行统计学分析。结果]249例中39例在术后1年内死亡(早期死亡组),其肿瘤的长度、浸润深度、淋巴结转移、TNM分期、淋巴结转移区域等与非早期死亡组相比差异有统计学意义(χ2=12.688、12.042、16.202、6.685、15.654,均P0.05)。行多因素分析发现发现肿瘤的长度≥4cm及淋巴结转移区域≥2个时是导致患者早期死亡最主要的危险因素(OR=2.305、4.370,95%CI:1.090~4.876、1.510~12.653,均P0.05)。根据这2个主要危险因素进行生存率分析,发现有0个、1个、2个危险因素的患者的1年生存率分别为90.5%、78.2%、46.1%。Log-rank统计学方法分析显示0个、1个、2个危险因素之间差异具有统计学意义(χ2=9.377、29.019、5.981,均P0.05)。结论]导致食管鳞癌患者早期死亡的最主要因素是肿瘤长度及淋巴结转移,因此对于存在肿瘤的长度≥4cm及淋巴结转移区域≥2个危险因素的患者,术后有必要进行其他干预治疗如辅助放化疗等,以尽可能延长患者的生存时间。

Analysis of risk factors for early mortality after radical surgery in patients with esophageal squamous cell carcinoma

Objective]To identify the risk factors for early cancer-related deaths after radical surgery in patients with esophageal squamous cell carcinoma.Methods]The clinical data of patients with esophageal squamous cell carcinoma and underwent radical resection were retrospectively analyzed in our hospital from January 2006 to December 2007.A 5-year follow-up was conducted.To analyze all the factors that could cause death in 1 year after surgery,ttest,Chi-square test or Fisher＇s exact tests was used.The factors including age,tumor location,tumor size,TNM stage,and so on.Univariate analysis and multivariate Cox regression model were used to determine the major risk factors that could cause patients＇ death earlier.Kaplan-Meier method and Log-rank test were used for the analysis of survival condition.Results]In 249 patients,39 patients who died of cancer within one year.Tumor size,T stage,N stage,TNM stage and lymph node metastasis region were different in the early death group comparing with the group of non-early death.The differences were statistically significant （x2 =12.688,12.042,16.202,6.685,15.654; all P＜ 0.05）.Multivariate analysis revealed that the length of the tumor ≥ 4 cm and lymph node metastasis area ≥2 were the main risk factors that caused early death（OR=2.305,4.370;95％CI：1.090-4.876,1.510-12.653 ;all P＜0.05）.Survival analysis was conducted according to the two risk factors（tumor length and lymph node metastasis regions）,it showed that patients with 0,1,2 risk factors; the 1-year survival rate were 90.5 ％,78.2 ％,46.1％.respectively.Log-rank analysis showed differences significantly among the three groups（x2 =9.377,29.019,5.981 ;all P＜0.05）.Conclusion]The main factors that lead to death earlier in patients with esophageal squamous cell carcinoma are tumor length and lymph node metastasis.So if there were two risk factors（tumor length ≥4 cm and lymph node metastasis regions≥2）before esophagectomy,it need to take other aggressive additional treatment such as