中国食管癌临床流行特征及外科治疗概况大数据分析  

Epidemiological characteristic and current status of surgical treatment for esophageal cancer by analysis of national registry database

作　　者：毛友生 高树庚 王群 师晓天[3] 李印[4] 高文俊 管福顺[6] 李小飞 韩泳涛[8] 刘永煜[9] 刘俊峰[10] 张康 柳硕岩[12] 付湘宁 方文涛[14] 陈龙奇 吴庆琛[16] 肖高明[17] 陈克能[18] 焦广根 张石江[20] 毛伟敏[21] 戎铁华[22] 傅建华[22] 谭黎杰 陈椿[23] 徐世东 郭石平[25] 于振涛[26] 胡坚[27] 胡振东[28] 杨逸坤 丁宁宁 杨丁 赫捷 Mao Yousheng;Gao Shugeng;Wang Qun;Shi Xiaotian;Li Yin;Gao Wenjun;Guan Fushun;Li Xiaofei;Han Yongtao;Liu Yongyu;Liu Junfeng;Zhang Kang;Liu Shuoyan;Fu Xiangning;Fang Wentao;Chen Longqi;Wu Qingchen;Xiao Gaoming;Chen Keneng;Jiao Guanggen;Zhang Shijiang;Mao Weimin;Rong Tiehua;Fu Jianhua;Tan Lijie;Chen Chun;Xu Shidong;Guo Shiping;Yu Zhentao;Hu Jian;Hu Zhendong;Yang Yikun;Ding Ningning;Yang Ding;He Jie(Department of Thoracic Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Thoracic Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Thoracic Surgery,Anyang Cancer Hospital,Anyang 455000,China;Department of Thoracic Surgery,Henan Cancer Hospital,Zhengzhou 450003,China;Department of Thoracic Surgery,Linzhou Renmin Hospital,Linzhou 456550,China;Department of Thoracic Surgery,Linzhou Cancer Hospital,Linzhou 456550,China;Department of Thoracic Surgery,affiliated Tandu Hospital of the Fourth Military University,Xian 710038,China;Department of Thoracic Surgery,Sichuan Cancer Hospital,Chengdu 610041,China;Department of Thoracic Surgery,Liaoning Cancer Hospital,Shenyang 110042,China;Department of Thoracic Surgery,the Fourth Hospital,Hebei Medical University,Shijiazhuang 050011,China;Department of Thoracic Surgery,Jining Renmin Hospital,Jining 272001,China;Department of Thoracic Surgery,Fujian Cancer Hospital,Fujian Medical University,Fuzhou 350014,China;Department of Thoracic Surgery,Tongji Hospital,Tongji University,Wuhan 430030,China;Department of Thoracic Surgery,Shanghai Chest Hospital,Shanghai 200030,China;Department of Thoracic Surgery,West China Hospital of Sichuan University,Chengdu 610041,China;Department of Thoracic Surgery,the First Affiliated Hospital,Chongqing Medical University,Chongqing 400016,China;Department of Thoracic Surgery,Hunan Cancer Hospital,Changsha 410000,China;Department of Thoracic Surgery,Beijing Cancer Hospital,Beijing Universi

机构地区：[1]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院胸外科,100021 [2]复旦大学附属中山医院胸外科,上海200032 [3]河南省安阳市肿瘤医院胸外科,455000 [4]河南省肿瘤医院胸外科,郑州450003 [5]河南省林州市人民医院胸外科,456550 [6]河南省林州市肿瘤医院胸外科,456550 [7]空军军医大学唐都医院胸外科,西安710038 [8]四川省肿瘤医院胸外科,成都610041 [9]辽宁省肿瘤医院胸外科,沈阳110042 [10]河北医科大学第四医院胸外科,石家庄050011 [11]山东省济宁市人民医院胸外科,272001 [12]福建省肿瘤医院胸外科,福州350014 [13]华中科技大学同济医学院附属同济医院胸外科,武汉430030 [14]上海市胸科医院胸外科,200030 [15]四川大学附属华西医院胸外科,成都610041 [16]重庆医科大学附属第一医院胸外科,400016 [17]湖南省肿瘤医院胸外科,长沙410000 [18]北京大学肿瘤医院胸外科,100142 [19]河南省林州市食管癌医院胸外科,456592 [20]江苏省人民医院胸外科,南京210029 [21]浙江省肿瘤医院胸外科,杭州310022 [22]中山大学附属肿瘤防治中心胸外科,广州510060 [23]福建医科大学附属协和医院胸外科,福州350001 [24]黑龙江省肿瘤医院胸外科,哈尔滨150081 [25]山西省肿瘤医院胸外科,太原030001 [26]天津市肿瘤医院胸外科,300060 [27]浙江大学医学院附属第一医院胸外科,杭州310003 [28]江苏省肿瘤医院胸外科,南京210009

出　　处：《中华肿瘤杂志》2020年第3期228-233,共6页Chinese Journal of Oncology

基　　金：国家科技支撑计划课题(2015BAI12B08)。

摘　　要：目的建立中国食管癌调查数据库以了解中国食管癌的临床流行特征和外科治疗状况。方法由计算机团队和胸外科临床专家团队合作开发网络平台临床资料数据库,简称"十一五食管癌临床治疗登记数据库",授权70家合作分中心将2009-2014年经外科治疗的食管癌病例录入数据库。结果8181例资料相对完整且有随访信息的外科治疗后食管癌病例入组。男性6052例,女性2129例;平均年龄60.5岁。食管癌发病相关因素的调查结果显示,1.8%(148例)的患者有心理创伤史;92.0%(7527例)的患者只有中学以下文化程度或未接受过任何教育;62.0%(5072例)的患者不经常吃新鲜蔬菜和水果;80.0%(6544例)的患者常吃粗粮;45.5%(3722例)的患者只能饮用未经处理的水;42.0%(3436例)的患者有不良进食习惯,包括6.2%(507例)的患者吃饭快,12.2%(998例)的患者喜食烫食,23.7%(1939例)的患者喜食油炸食品;53.9%(4410例)的患者有吸烟史;34.5%(2822例)的患者有经常性饮酒史。鳞癌7813例,占95.5%;腺癌267例,占3.3%;腺鳞癌25例,占0.3%;小细胞癌50例,占0.6%。1800例(22.0%)患者因病变较晚或切除有困难接受术前辅助治疗。5870例(71.8%)患者接受左侧开胸入路手术治疗,2215例(27.1%)患者接受右胸入路手术治疗。96例(1.2%)患者接受其他途径外科治疗。8001例(97.8%)患者接受根治性手术切除治疗,180例(2.2%)患者接受姑息性手术切除治疗。术后30 d内死亡率为0.5%(43例),术后Ⅱ级以上并发症的发生率为11.6%(951例),术后1、3、5年总生存率分别为82.6%、61.6%和52.9%。结论大数据结果显示,食管癌的发生可能与不良饮食习惯、经济社会地位低、常吃粗粮、不能常吃蔬菜水果以及吸烟和饮酒等有关。但仍需要通过队列观察研究的证据支持。外科技术的提升以及综合治疗的合理应用使中国食管癌患者的长期生存率有所提高。Objective To investigate the epidemiological characteristics and current status of surgical management for esophageal cancer in China.Methods A national database was setup through a network platform.The clinical data of esophageal cancer treated by surgery was collected from 70 major hospitals in China between January 2009 and December 2014.Results Complete data of 8181 cases of esophageal cancer patients who underwent surgery were recorded in the database and recruited in the analysis.Among them,6052 cases were male and 2129 were female,the average age was 60.5 years.The epidemiological investigation results showed that 148 cases(1.8%)had history of psychological trauma,7527 cases(92.0%)were lower social economic status,5072 cases(62.0%)were short of fresh vegetables and fruits,6544 cases(80.0%)ate rough food frequently,3722 cases(45.5%)drank untreated water directly from lake or river or shallow well,3436 cases(42.0%)had a unhealthy eating habit,including habits of eating food fast(507 cases,6.2%),eating hot food or drinking hot tea/soup(998 cases,12.2%),eating fried food(1939 cases,23.7%),4410 cases(53.9%)had the habits of smoking cigarettes and 2822 cases(34.5%)drank white wine frequently.The pathological results showed that 7813 cases(95.5%)were squamous cell carcinoma,267 cases were adenocarcinoma(3.3%),25 cases were adenosquamous cell carcinoma(0.3%)and 50 cases were small cell carcinoma(0.6%).A total of 1800 cases(22.0%)received preoperative neoadjuvant therapy due to locally advanced disease or difficulty of resection.The esophagectomies were performed through left thoracotomy approach in 5870 cases(71.8%),through right chest approach in 2215 cases(27.1%),and the remain 96 cases(1.2%)received surgery though other approaches.A total of 8001 cases(97.8%)underwent radical resection,the other 180 cases(2.2%)received palliative resection.The 30-day postoperative mortality rate was 0.5%,the overall≥gradeⅡpostoperative complication rate was 11.6%(951 cases).The 1-yr,3-yr,and 5-yr overall actual survival rat

关 键 词：食管肿瘤 大数据分析 流行病学特征 外科治疗 

分 类 号：R735[医药卫生—肿瘤]