食管癌根治术后生存状态的5年随访研究  

Survival status of patients with esophageal cancer after esophagectomy:a five-year follow-up study

作　　者：李林峻[1] 张诚[1] 张敏[1] 陈丹[1] 吴庆琛[1] 蒋迎九[1] 李强[1] 

机构地区：[1]重庆医科大学附属第一医院胸心外科,重庆400016

出　　处：《重庆医科大学学报》2017年第10期1340-1344,共5页Journal of Chongqing Medical University

基　　金：重庆市卫生局重点资助项目(编号:20121015)

摘　　要：目的:了解食管癌根治术后生存状态,探索影响预后的相关因素,明确消化道重建方式对预后的影响。方法:以我科2007至2008年期间104例食管癌根治术后患者为研究对象,随机分为管状胃代食管组(narrow gastric tube,NGT,n=52)和全胃代食管组(whole stomach,WS,n=52);调查研究采用问卷形式,问卷的设计和制定均参照欧洲癌症研究与治疗组织(European Organization for Research and Treatment of Cancer,EORTC)生活质量调查QLQ-C30量表及QLQ-OES18食管癌专用量表,分别以术后3个月、6个月、1年、2年、3年、4年、5年进行随访。纳入年龄、性别、吸烟、饮酒、并发症、TNM分期、淋巴结状态、消化道重建方式8个因素进行分析;采用Life Tables法、Kaplan-Meier法进行生存分析,Log Rank检验、Cox模型回归分析筛选影响预后的相关因素。结果:(1)术后第1、3、5年累积生存率分别为89%、52%、35%,中位生存时间39.60个月;(2)采用后退法(Back:LR)多因素Cox回归分析显示:保留在模型的因素为消化道重建方式(RR=1.798,95%CI=1.084~2.983,P=0.023);淋巴结状态(RR=3.532,95%CI=1.569~7.951,P=0.002);TNM分期(P=0.010)是影响食管癌预后因素。结论:淋巴结状态、TNM分期、消化道重建方式是影响预后的危险因素,管状胃代食管的手术方式可改善患者预后。Objective：To focus on the long-term survival in patients after esophagectomy for cancer and to compare the different methods of reconstruction. Methods：In a prospective randomized single-center study from 2007 to 2008,104 patients undergoing esophageal resection were double-blindly randomly divided into experimental group （52 cases） who received the esophageal recon- struction with the narrow gastric tube（NGT） and control group（52 cases） who received the esophageal reconstruction with the whale stomach （WS）. A questionnaire in reference to the European Organization for Research and Treatment of Cancer（EORTC） QLQ-C30 and the QLQ-OES18 was administered at 3 weeks, 6 months, 1 year, 2 years, 3 years, 4 years and 5 years after surgery. Clinical data were collected prospectively, and follow-up was performed regularly. Eight factors including age, sex, smoking, drinking, complications, TNM staging,lymph node metastasis and methods of reconstruction were analyzed. The method of Life Tables, Kaplan-Meier, Log Rank and Cox were used. Results：The cumulative survival at 1,3,5 years after surgery was 89%, 52% and 35%, respectively. The median survival was 39.6 moths. Methods of reconstruction （RR = 1.798,95%CI= 1.084 to 2.983, P=0.023）, lymph node metastasis （RR=3.532, 95%CI=1.569 to 7.951,P=0.002） and TNM staging（P=0.010） are factors influencing patients＇ survival. Conclusion：Narrow gastric tube reconstruction after oncologic esophagectomy leads to a better survival. TNM staging and lymph node metastasis are independent factors influencing survival.

关 键 词：食管癌术后 生存分析 随访研究 生存状态 

分 类 号：R655.4[医药卫生—外科学]