胃食管结合部癌514例外科治疗结果及其预后分析  

Surgical treatment results and prognostic analysis of 514 cases with gastroesophageal junction carcinoma

作　　者：杨宏[1] 武爱文[1] 李子禹[1] 步召德[1] 张连海[1] 吴晓江[1] 宗祥龙[1] 李双喜[1] 陕飞[1] 杨跃[2] 季加孚[1] 

机构地区：[1]北京大学临床肿瘤学院北京肿瘤医院暨北京市肿瘤防治研究所恶性肿瘤发病机制及转化研究教育部重点实验室胃肠肿瘤外科,100142 [2]北京大学临床肿瘤学院北京肿瘤医院暨北京市肿瘤防治研究所恶性肿瘤发病机制及转化研究教育部重点实验室胸部肿瘤外科,100142

出　　处：《中华外科杂志》2010年第17期1289-1294,共6页Chinese Journal of Surgery

基　　金：十一五国家科技支撑计划资助项目（2006BAI02A06）;国家高新技术研究发展专项经费资助项目（2006AA02A402）;首都医学发展科研基金资助项目（2007-2051）;北京市科技新星计划资助项目（2007-B057）

摘　　要：目的 探讨影响胃食管结合部癌患者预后的临床病理因素.方法 回顾性分析1995年9月至2007年1月接受外科手术治疗的514例胃食管结合部癌患者的临床资料,统计分析患者临床病理因素和治疗措施对预后的影响.结果 全组514例患者,男性424例,女性90例,中位年龄63岁.全组1、3、5年生存率分别为74.8%、42.1%和29.1%.Kaplan-Meier法单因素分析显示,患者的性别、年龄与生存无明显相关性,而肿瘤大体分型、组织学类型、TNM分期、有无脉管癌栓及是否接受根治手术是影响患者预后的因素.经腹与经胸手术相比,两组患者的生存曲线未见显著差异（P＞0.05）;对于分期≥Ⅱ期的患者,近端胃大部切除和全胃切除亦未显示生存差异（P＞0.05）;而对于Ⅱ、Ⅲ期患者,术前化疗患者的预后要优于术前无化疗者（P＜0.05）.采用Cox模型进行多因素分析显示,TNM分期和有无脉管癌栓是影响患者预后的独立因素.结论 TNM分期和有无脉管癌栓是影响患者预后的独立因素,对于Ⅱ、Ⅲ期患者,术前新辅助化疗可改善患者预后.手术应尽可能做到根治,并根据肿瘤的位置、大小、分期等因素选择合适的手术路径和切除范围.Objective To clarify the important clinicopathological and therapeutical factors affecting the prognosis of patients with gastroesophageal junction carcinoma. Methods Data of 514 cases with gastroesophageal junction carcinoma who underwent surgical treatment from September 1995 to January 2007 was retrospectively analyzed. Relevant prognostic factors were studied with univariate and multivariate analysis. Results For all 514 cases （424 men and 90 women）, the median age was 63 years. The 1-, 3- and 5-year survival rates of this group were 74.8%, 42.1% and 29.1%, respectively. Gross type, TNM classification, histological type, vascular invasion and extent of surgical resection affected patients＇ survival remarkably. There was no significant difference in survival between operative approaches （via laparotomy or left thoracotomy） （ P 〉 0.05 ）. Long-term survival was similar between proximal subtotal gastrectomy and total gastrectomy in advanced cases （ P 〉 0.05 ）. For stage Ⅱ and Ⅲ tumors, patients with neoadjuvant chemotherapy had better prognosis than those without （ P 〈 0.05 ）. Cox multivariate regression analysis revealed TNM classification and vascular invasion were independent prognostic factors. Conclusions TNM classification and vascular invasion are independent prognostic factors for gastroesophageal junction carcinoma. Neoadjuvant chemotherapy may improve prognosis of the patients with stage Ⅱ and Ⅲ tumors.Radical resection should be achieved with rational surgical procedures tailored by tumor position, size,staging and so on.

关 键 词：胃食管结合部癌 外科手术 预后 

分 类 号：R735.2[医药卫生—肿瘤]