pN0期胸段食管鳞状细胞癌术后复发转移模式分析  

Recurrence pattern of histological node-negative squamous cell carcinoma of the thoracic esophagus after extended radical esophagectomy with lymphadenectomy

作　　者：郭旭峰[1,2] 方文涛[1,2] 茅腾[1,2] 谷志涛[1,2] 杨煜[1,2] 陈文虎[1,2] 

机构地区：[1]上海交通大学医学院附属胸科医院胸外科,200030 [2]上海交通大学食管疾病诊治中心,200030

出　　处：《中华外科杂志》2013年第10期908-911,共4页Chinese Journal of Surgery

摘　　要：目的 分析pN0期胸段食管鳞状细胞癌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月连续收治的112例pN0期胸段食管鳞状细胞癌患者临床病理资料.其中男性92例,女性20例；年龄36 ～ 80岁,平均60.3岁.对患者的随访资料进行分析,多因素分析采用Cox比例风险回归模型判定术后3年内复发转移的独立危险因素.结果 术后3年内复发转移率为40.2％（45/112）,中位复发转移时间为17.4个月.其中局域性复发38例（33.9％,占复发转移总例数的84.4％）,血行转移7例（6.3％）.不同肿瘤位置、组织学分化程度、pT分期及病理分期的患者复发转移率差异有统计学意义（x2 =6.380～ 18.837,P＜0.05）.多因素分析结果显示,肿瘤位于胸上中段（RR=1.092,P =0.049）和pT3-4a期（RR=3.296,P=0.017）为pN0期胸段食管鳞状细胞癌术后局域性复发转移的独立危险因素.结论 pN0期食管鳞状细胞癌患者术后3年内出现肿瘤复发转移以局域性复发转移最常见.肿瘤位于胸上中段和pT3-4a期是pN0胸段食管鳞状细胞癌术后局域性复发转移的独立危险因素.Objective To analyze the clinical and pathologic influencing factors of early recurrence in patients with histological node-negative （pN0 stage） esophageal squamous cell carcinoma after radical esophagectomy.Methods A retrospective study on 112 consecutive pN0 stage esophageal squamous cell carcinoma patients who underwent esophagectomy with lymphadenectomy by the same surgical team from January 2004 to December 2010.There were 92 male and 20 female patients,aging from 36 to 80 years with a mean age of 60.3 years.The Cox proportional hazards model was used to determine the independent risk factors for recurrence within 3 years after the operation.Results Recurrence was recognized in 45 patients （40.2%） within 3 years after operation.The median time to tumor recurrence was 17.4 months.Locoregional recurrence was found in 38 patients （33.9%）,and hematogenous metastasis in 7 patients （6.3%）.Recurrence closely correlated with tumor location,grade of differentiation,pT stage and pathologic stage （x2 =6.380 to 18.837,P 〈 0.05）.The Cox multivariate analysis showed that tumor location （RR =1.092,P =0.049） and pT3-4a stage （RR =3.296,P =0.017） were independent risk factors for postoperative locoregional recurrence.Conclusions The most common recurrence pattern of patients with pN0 esophageal squamous cell carcinoma would develop recurrence within 3 years after operation is locoregional recurrence.Upper/middle thoracic location and pT3-4a stage are independent risk factors for locoregional recurrence of pN0 esophageal squamous cell carcinoma after operation.

关 键 词：食管肿瘤 淋巴结清扫 复发转移 

分 类 号：R735.1[医药卫生—肿瘤]