pT1胸段食管鳞癌根治术后复发转移的危险因素分析  

Survival and Risk factors of treatment failure in pT1 thoracic esophageal squamous cell carcinoma after radical resection

作　　者：彭凯明 林济红[1] 余绍斌 陈舒晨[1] 韩子阳[1] 陈明端 康明强[1,2] PENG Kaiming;LIN Jihong;YU Shaobin(Department of Thoracic Surgery,Fujian Medical University Union Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院胸外科福建省胸心外科研究所,福州350001 [2]福建医科大学附属协和医院消化道恶性肿瘤教育部重点实验室福建省肿瘤微生物重点实验室

出　　处：《临床外科杂志》2018年第9期657-661,共5页Journal of Clinical Surgery

摘　　要：目的分析pT 1胸段食管鳞状细胞癌(thoracic esophageal squamous cell carcinoma)患者术后疗效及复发转移的危险因素,探讨pT 1食管癌术后的治疗方案。方法收集131例pT 1胸段食管鳞状细胞癌患者的病理和临床资料。采用SPSS 21. 0统计学软件进行统计分析。结果截止2018年1月,共有34例(25. 95%)患者死亡,27例死于肿瘤本身,另外有7例死于其他原因。随访期间出现28例(21. 4%)局部复发和(或)远处转移,其中局部-区域性复发15例(11. 45%),远处转移9例(6. 87%),出现局部区域性复发合并远处转移4例(3. 05%)。全组患者的1、3、5年的总生存时间(OS)率和无进展生存率(PFS)分别为96. 9%和90. 8%、86. 3%和80. 2%、71. 0%和69. 5%。单因素分析显示淋巴结转移、脉管瘤栓、浸润深度和嗜酒史是pT 1食管癌根治术后患者出现复发转移的独立危险因素(P <0. 05);多因素分析发现脉管瘤栓和嗜酒史是本组pT 1食管鳞癌患者术后出现局部复发和(或)远处转移的独立危险因素(P <0. 05)。Kaplan-Meier法分析提示淋巴结转移、脉管瘤栓、嗜酒史、肿瘤长度> 2. 0 cm为术后PFS和OS的独立危险因素(P <0. 05);多因素COX回归分析提示脉管瘤栓、肿瘤长度> 2. 0 cm、肿瘤低分化程度、嗜酒史是pT 1食管鳞癌术后影响PFS和OS的独立危险因素(P <0. 05);肿瘤长度和嗜酒史是pT 1N0食管鳞癌术后PFS和OS的独立危险因素。结论在pT 1期胸段食管鳞癌根治术后仍有21. 4%患者出现局部复发和(或)远处转移,浸润深度、肿瘤长度、淋巴结转移、肿瘤分化程度、脉管瘤栓及嗜酒史是影响其治疗效果的危险因素。这部分患者术后应该制定更加密集的随访策略,而适当的术后辅助治疗或有助于降低术后复发转移风险及改善预后。Objective Retrospective analysis of prognosis,recurrence and metastasis after treatment of significance and operation assisted radical postoperative stage pT 1 squamous cell carcinoma of thoracic esophagus. Methods 131 cases of stage pT 1 thoracic esophageal cancer which were diagnosized and treated with radical resection. SPSS 21. 0 statistical software was used to statistical analysis. Results The end of follow-up was January,2018. During the follow-up period,34（ 25. 95%） patients died,27 died from the tumor itself,and 7 died from other causes. 28 cases（ 21. 4%） was local recurrence and/or distant metastasis,which including 15 cases（ 11. 45%） of local regional recurrence,9 cases（ 6. 87%） of distant metastasis and 4 cases（ 3. 05%） of local regional recurrence combination of distant metastasis. The 1-,3-,5-year overall survival（ OS） rates were 96. 9%,90. 8%,86. 3%,respectively; the 1-,3-,5-year rates of progression free survival（ PFS） were 80. 2%,71. 0%,69. 5%,respectively. Univariate analysis showed lymphatic metastasis,vascular invasion,depth of invasion and drinking were the independent risk factors for local recurrence and（ or） distant metastasis in patients with pT 1 esophageal squamous carcinoma（ P〈0. 05）,with multivariate analysis,vascular invasion and drinking were the independent risk factors for local recurrence and（ or） distant metastasis in patients with pT 1 esophageal squamous carcinoma（ P〈0. 05）. The Kaplan-Meier method remind lymphatic metastasis,vascular invasion,drinking and tumor size（ 〉2. 0 cm） were the independent risk factors for OS and PFS（ P〈0. 05）; COX＇S regression model remind vascular invasion,drinking,tumor size（ 〉2. 0 cm）,differentiation degree and tumor length were theindependent risk factors for OS and PFS（ P〈0. 05）. Conclusion For patients of stage pT 1 squamous cell carcinoma of thoracic esophagus after radical resection,there were still 21. 4% of patients with local recurrence and/or distant metastasis. Pos

关 键 词：pT1食管鳞癌 食管癌根治术 复发 转移 辅助治疗 

分 类 号：R735.1[医药卫生—肿瘤]