肥城市食管鳞癌及其癌前病变患者远期生存情况分析  

Long term survival of esophageal squamous cell carcinoma and precancerous lesions in Feicheng City

作　　者：李琰琰 卢培培 郑春娟 王贵齐 魏文强 赵德利 王家林 LI Yan-yan;LU Pei-pei;ZHENG Chun-juan;WANG Gui-qi;WEI Wen-qiang;ZHAO De-li;WANG Jia-lin(Cancer Center,People's Hospital of Feicheng Feicheng 271600,P.R.China;School of Medicine and Life Sciences,Shandong Academy of Medical Sciences,University of Jinan,Jinan 250022,P.R.China;Chinese Academy of Medical Sciences,Peking Union Medical College,Cancer Registry Office,Beijing 100021,P.R.China;Department of Education and Prevention Shandong Cancer Hospital and Institute Shandong First Medical University and Shandong Academy of Medical Sciences,Jinan 250117,P.R.China)

机构地区：[1]肥城市人民医院肿瘤防治中心,山东肥城271600 [2]济南大学•山东省医学科学院医学生命与科学学院,山东济南250022 [3]中国医学科学院•北京协和医学院肿瘤医院肿瘤登记办公室,北京100021 [4]山东省肿瘤防治研究院(山东省肿瘤医院)教育预防部,山东第一医科大学(山东省医学科学院),山东济南250117

出　　处：《中华肿瘤防治杂志》2020年第15期1183-1188,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：国家自然科学基金面上项目(81573246);国家重点研发计划项目(2016YFC1302800,2016YFC0901400);山东省科技发展计划项目(2017GSF18101);山东省自然科学基金(ZR2019PG006)。

摘　　要：目的食管癌发病率和死亡率较高,且预后较差,本研究旨在分析筛查后食管癌癌前病变、早期癌及进展期癌患者治疗后远期生存情况,为食管癌防治提供参考依据。方法收集肥城市人民医院2006-09-07-2018-09-06行内镜下治疗及食管癌根治术的330例患者临床资料,采用Kaplan-Meier法及Cox分析食管癌癌前病变、早期食管癌及进展期癌的远期生存情况。结果330例患者中,男210例,女120例;患者1、3、5和10年生存率分别为99.09%、95.76%、91.21%和90.91%;Cox多因素回归分析结果显示,治疗方式(RR=3.383,95%CI:1.633~7.009,P=0.001)以及病理类型为重度异型增生和原位癌(RR=1.413,95%CI:1.006~1.983,P=0.046)、黏膜下癌(RR=6.019,95%CI:2.186~16.570,P=0.001)和浸润癌(RR=6.640,95%CI:2.417~18.370,P<0.001)是影响患者生存时间的主要因素。术前诊断为重度异型增生和原位癌、黏膜内癌并采用内镜下微创治疗的患者,5年生存率分别为96.70%和93.70%,而接受食管癌根治术的黏膜下癌和浸润癌患者5年生存率分别为82.70%和78.20%,差异有统计学意义,P<0.001。结论重度异型增生和原位癌、黏膜内癌采用微创治疗可获得较好的远期疗效,其远期生存好于接受食管癌根治术的黏膜下癌及进展期浸润癌,在继续开展食管癌早诊早治工作的基础上,应对不同分期食管癌患者采用不同治疗方式,在保证治疗效果前提下,进一步减少创伤,加快患者康复,提高患者生活质量。OBJECTIVE The incidence and mortality of esophageal cancer are high,and the prognosis is poor.This paper aimed to analyze the long-term survival of patients with precancerous lesion,early cancer and advanced cancer after treatment,so as to provide reference for the prevention and treatment of esophageal cancer.METHODS A total of 330 patients in People’s Hospital of Feicheng were selected and divided into two groups,the endoscopic resection group and radical resection group.The Kaplan-Meier method and Cox analysis were used to compare the difference of long-term survival between the two groups.RESULTS Among 330 patients,210 were male and 120 were female.The 1-,3-,5-,and 10-year survival rates of 330 patients were 99.09%,95.76%,91.21%and 90.91%,respectively.In Cox multivariate regression analysis,the main factors affecting the survival time were the treatment(RR=3.383,95%CI was 1.633-7.009,P=0.001),severe dysplasia/carcinoma in situ(RR=1.413,95%CI was 1.006-1.983,P=0.046),submucosal cancer(RR=6.019,95%CI was 2.186-16.570,P=0.001),invasive cancer(RR=6.640,95%CI was 2.417-18.370,P<0.001).The 5-year survival rates were 96.70%and 93.70%for patients with severe dysplasia/carcinoma in situ and intramucosal carcinoma,and 82.70%and 78.20%for patients with submucosal carcinoma and invasive carcinoma,respectively,with statistical significance(P<0.001).CONCLUSIONS Endoscopic resection can get preferable long-term outcomes for patients with esophageal precancerous lesions and intramucosal carcinoma,and it’s better than that of patients with advanced esophageal cancer underwent radical resection.On the basis of carrying out early diagnosis and treatment of esophageal cancer,we should adopt different treatment methods to deal with different stages of esophageal cancer patients.On the premise of ensuring the treatment effect,we should further reduce the trauma,accelerate the recovery of patients,and improve the quality of life of patients.

关 键 词：早期食管癌 内镜下治疗 手术治疗 远期生存 

分 类 号：R735.1[医药卫生—肿瘤]