食管癌337例术后腹腔淋巴状态对腹腔复发率及预后的影响

目的分析食管癌术后腹腔淋巴结状态对腹腔复发率影响,为术后腹部放疗提供依据。方法回顾性分析2012-01-01-2018-08-01扬中市人民医院胸外科收治的337例ⅠA~ⅣA期食管癌术后患者的临床资料,分析腹腔复发率。结果食管癌术后腹腔淋巴结阳性患者1、3、5年腹腔无复发生存率分别为83.6%、69.6%和64.7%,腹腔淋巴结阴性患者分别为96.9%、93.0%和86.3%,差异有统计学意义,χ²=21.102,P<0.001。1、3、5年无转移生存率腹腔淋巴结阳性患者分别为84.7%、69.6%和69.6%,腹腔淋巴结阴性患者分别为95.1%、91.0%和88.3%,差异有统计学意义,χ²=13.392,P<0.001。1、3、5年累积生存率腹腔淋巴结阳性患者分别为77.2%、54.0%和54.0%,腹腔淋巴结阴性患者分别为93.0%、74.8%和66.7%,差异有统计学意义,χ²=8.290,P=0.004。腹腔淋巴结状态是术后腹腔复发的独立预后因素之一,HR=3.496,95%CI:1.665~7.342,P=0.001。中/下段食管癌、T3患者术后腹腔淋巴结阳性较阴性有更高的腹腔转移概率,差异有统计学意义,均P<0.05。结论术后腹腔淋巴结阳性患者腹腔复发率增加,与腹腔高复发危险因素结合可精确筛选腹腔预防照射人群。

Effect of abdominal lymphatic status on abdominal recurrence rate and prognosis in 337 patients with esophageal carcinoma

Objective To analyze the effect of postoperative celiac lymph node status on abdominal recurrence rate in order to provide basis for postoperative abdominal radiotherapy.METHODS The clinical data of 337 patients with stageⅠA-Ⅳesophageal cancer treated in the Department of Thoracic surgery of Yangzhong People’s Hospital from January 1,2012 to August 1,2018 were analyzed retrospectively.The recurrence rate of abdominal cavity was analyzed.RESULTS the1-,3-and 5-year recurrence-free survival rates of patients with positive and negative abdominal lymph after operation of esophageal cancer were 83.6%,69.6%,64.7%and 96.9%,93.0%,86.3%,respectively.The difference was statistically significant(χ²=21.102,P<0.001).The 1-,3-and 5-year metastasis-free survival rates were 84.7%,69.6%,69.6%and 95.1%,91.0%,88.3%,respectively,and the difference was statistically significant(χ²=13.392,P<0.001).The1-,3-and 5-year cumulative survival rates were 77.2%,54.0%,54.0%and 93.0%,74.8%,66.7%,respectively.The difference was statistically significant(χ²=8.290,P=0.004).The status of celiac lymph nodes was one of the independent prognostic factors of postoperative abdominal recurrence(HR=3.496,95%CI:1.665-7.342,P=0.001).The positive rate of abdominal lymph nodes in patients with middle and lower esophageal cancer was higher than that in patients with negative abdominal lymph nodes,and the difference was statistically significant(all P<0.05).CONCLUSIONS The recurrence rate of abdominal cavity in patients with positive abdominal lymph nodes after operation is increased.Combined with the risk factors of high recurrence of abdominal cavity,it is possible to accurately screen the population for prevention of abdominal irradiation.