食管鳞癌切除术后切缘癌残留的影响因素及预后  

Associated factors and prognosis of residual cancer after esophagectomy for squamous cell carcinoma of the esophagus

作　　者：郑斌[1] 胡祎[1] 王军业[1] 杨弘[1] 林鹏[1] 傅剑华[1] 

机构地区：[1]中山大学肿瘤防治中心胸外科华南肿瘤学国家重点实验室,广州510060

出　　处：《中华胃肠外科杂志》2010年第1期44-47,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的 探讨食管鳞癌切除术后切缘癌残留的影响因素和预后,评价术后补救性治疗的价值.方法 回顾性总结中山大学肿瘤防治中心1997年1月至2003年6月连续收治的1074例行食管鳞癌切除术患者的临床与病理资料,分析肿瘤分化程度、部位、病变长度、切口选择、吻合位置、T分期、N分期与切缘癌残留发生率的关系,并通过生存分析探讨补救性治疗的方式.结果 本组44例（4.3%）出现切缘癌残留.食管端切缘癌残留在病变位于胸上段时发生率为6.5%;胃端切缘癌残留在病变位于胸下段时发生率为0.8%.切缘癌残留发生率随T分期和N分期的增加而升高（均P＜0.05）.Logistic回归分析显示,T分期和N分期是术后切缘癌残留发生的危险因素.切缘癌残留患者3年生存率为22.7%.生存时间（25.2±3.3）个月.术后行补救性治疗者20例（45.5%,其中行放疗18例,行联合放化疗2例）：另24例（54.5%）未行补救性治疗.术后行补救性治疗与未行补救性治疗患者的3年生存率分别为53.2%与7.8%（P=0.027）.结论 肿瘤浸润程度和淋巴结转移是食管鳞癌切除术后切缘癌残留发生的危险因素;术后行补救性治疗可明显提高生存率.Objectives To analyze associated factors and the prognosis of patients with residual cancer after esophagectomy for squamous cell carcinoma of the esophagus,and to assess outcomes after salvage treatment.Methods Clinical and pathological data of 1074 patients with squamous cell carcinoma of the esophagus who underwent esophagectomy in the Cancer Center of Sun Yat-sen University from 1997 to 2003 were analyzed retrospectively.The relationship between the associated factors （differentiation,location,length of the lesion,surgical route,anastomosis site,T stage,N stage） and the incidence of residual cancer was analyzed,using the chi-squared test and Logistic regression analysis methods.The value and the modality of the salvage treatment were investigated.Results Forty-four patients had residual cancer （4.3%）.Cancers in the upper esophagus were associated with the highest incidence of residual cancer on esophageal stump （6.5%）,while the lower esophagus had the highest incidence of residual cancer on gastric stump （0.78%）.The Incidence correlated with T and N stage.Logistic regression analysis showed that T and N stage were the risk factors of residual cancer.Three-year survival rate was 22.7% in patients with residual cancer.The mean survival time was 25.2±3.3 months.Three-year survival rates of patients with and without salvage treatment were 53.2% and 7.8%,respectively（P=0.027）.Three-year survival rate of patients with salvage radiotherapy was 56.0%.Conclusions Advanced T and N stage are the risk factors of residual cancer after esophagectomy in the patients with squamous cell carcinoma of the esophagus.Salvage treatment can improve the survival of the patients.

关 键 词：食管肿瘤 肿瘤 残余 食管切除术 挽救疗法 预后 

分 类 号：R735.1[医药卫生—肿瘤]