胸段食管鳞癌切除术后的预后分析  

Prognostic evaluation after esophagectomy for squamous cell carcinoma of thoracic esophagus

作　　者：杨林[1] 冯伦高[1] 叶世铎[1] 王家顺[1] 翟伟[1] 

机构地区：[1]同济医科大学附属协和医院胸外科,湖北武汉430022

出　　处：《癌症》2000年第11期1008-1011,共4页Chinese Journal of Cancer

摘　　要：目的：应用 Cox模型和 Kaplan- Meier生存分析方法，对可能影响食管鳞癌术后生存时间的临床和病理因素的相关性进行了分析。方法：我科 1991年 8月～ 1996年 3月行胸段食管癌切除术并经病理证实为原发性食管鳞癌的患者共 136例，排除手术死亡 4例，有完整随访资料的 115例。结合临床和病理情况及预后相关资料，选择性别、年龄、肿瘤部位等 14个有关食管鳞癌术后生存的非重复特征性因素进行分层，应用 STATA 5.0计算机统计软件行单因素和多因素分析。结果： 115例胸段食管鳞癌的术后中位生存期为 37个月， 1， 3， 5年术后生存率分别为 92.1％， 51.5％， 30.2％。单因素分析结果表明：食管鳞癌病变长度≥ 5 cm的患者比<3 的预后差，术后病检残端癌阳性的比阴性的预后差，有淋巴结转移的患者比无淋巴结转移的预后差，且转移淋巴结数量越多，预后越差，肿瘤浸润食管壁越深， ＴＮＭ 分期越晚，预后越差。进一步Ｃox 多因素分析表明只有肿瘤浸润深度和转移淋巴结数量是胸段食管鳞癌的独立预后因素。结论：目前食管癌 ＴＮＭ分期标准没有考虑到转移淋巴结的数量在食管癌预后中的重要意义，导致不能很准确的判断预后，因而需改进和修正。对中晚期食管鳞癌，尤其是位于胸中上段食管鳞癌可以考虑术前术后辅?Objective： One of the primary goals of pathologic examination of esophageal squamous cell carcinoma (ESCC) resection specimens is to provide information regarding morphologic features which can help to make prognosis and guide management of affected patients. The purpose of this study was to determine the prognostic utility of a variety of histopathologic prognostic factors in patients with thoracic ESCC. Method： Among 136 patients with primary thoracic ESCC who underwent esophagectomy between August 1991 and March 1996, 115 cases who had complete clinical following- up data were retrospectively investigated by Kaplan- Meier product- limit method and Cox proportional hazards model. Results： The 1- , 3- , and 5- year overall survival rates in the 115 patients were 92.1％ , 51.5％ , and 30.2％ , respectively. The factors influencing the survival rate were size of tumor, residual tumor of resecting end, depth of invasion (pT), metastases of lymph node(pN), number of lymph node metastases and TNM stage. Among those significant variables, independent prognostic factors for survival determined by multivariate analysis were pT and number of lymph node metastases. In 49 patients belong to StageⅢ－Ⅳ , the Kaplan- Meier survival curve showed that the group with radiotherapy before or/and after resection had a longer survival time. Conclusion： pT category and number of lymph node metastases play an important role in evaluating the prognosis of throracic ESCC. The present TNM staging system should be modified because it can not estimate prognosis correctly. And radiotherapy combined with surgery can improve survival rate of middle and late stage ESCC.

关 键 词：胸段食管鳞癌 生存率 预后 外科手术 

分 类 号：R735.1[医药卫生—肿瘤]