SiewertⅡ和Ⅲ型食管胃结合部腺癌219例预后相关因素分析  

Analysis of prognostic factors in 219 patients with Siewert typeⅡand type Ⅲ adenocarcinoma of esophagogastric junction

作　　者：蒋继文[1,2] 戎亚雄 单国平[1] 陈飞[1] 冯舒 JIANG Ji-wen;RONG Ya-xiong;SHAN Guo-ping;CHEN Fei;FENG Shu(Department of General Surgery,Wujin Hospital Affiliated to Jiangsu University,Changzhou 213002,P.R.China;Wujin Clinical College,Xuzhou Medical University,Xuzhou 221004,P.R.China)

机构地区：[1]江苏大学附属武进医院普外科,江苏常州213002 [2]徐州医科大学武进临床学院,江苏徐州221004

出　　处：《中华肿瘤防治杂志》2020年第17期1409-1414,共6页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的近年来食管胃结合部腺癌(adenocarcinoma of esophagogastric junction,AEG)发病率明显上升,AEG预后较差,影响其预后的因素很多。本研究探讨SiewertⅡ和Ⅲ型AEG患者的预后因素,为临床制订治疗方案提供依据。方法回顾性分析2007-01-01-2011-12-31江苏大学附属武进医院收治的219例行经腹入路根治性切除+D2淋巴结清除术的SiewertⅡ和Ⅲ型AEG患者临床资料。采用Kaplan-Meier法绘制生存曲线和计算生存率,Log-rank检验单因素分析,Cox比例风险回归模型多因素分析。结果219例SiewertⅡ和Ⅲ型AEG患者均获术后随访,随访时间为3~71个月,中位随访时间为60个月,随访期间死亡68例。219例SiewertⅡ和Ⅲ型AEG患者术后1、3、5年总体生存率分别为91%、70%和55%。单因素分析结果显示,淋巴结转移率(χ^2=65.070,P<0.001)、pN分期(χ^2=50.724,P<0.001)、TNM分期(χ^2=44.438,P<0.001)、肿瘤直径(χ^2=11.416,P=0.001)、浸润深度(χ^2=24.628,P<0.001)、手术方式(χ^2=8.633,P=0.003)、年龄(χ^2=4.476,P=0.034)、癌胚抗原(χ^2=18.464,P<0.001)及糖类抗原19-9(χ^2=14.405,P<0.001)水平与患者预后有关联。多因素分析显示,淋巴结转移率(HR=1.830,95%CI:1.353~2.477,P<0.001)、pN分期(HR=1.681,95%CI:1.243~2.273,P=0.001)、TNM分期(HR=1.865,95%CI:1.061~3.279,P=0.030)和癌胚抗原(HR=1.807,95%CI:1.026~3.182,P=0.040)水平是影响患者预后的独立危险因素。结论淋巴结转移率、pN分期、TNM分期和癌胚抗原水平是影响SiewertⅡ和Ⅲ型AEG患者预后的独立危险因素。OBJECTIVE In recent years,the incidence of adenocarcinoma of esophagogastric junction(AEG)has increased significantly,its prognosis is poor,and many factors affect its prognosis.The purpose of this study was to investigate the prognostic factors of patients with Siewert typeⅡand typeⅢAEG,and to provide basis for the development of clinical treatment plans.METHODS The clinical data of 219 patients with Siewert typeⅡand typeⅢAEG treated in Wujin Hospital Affiliated to Jiangsu University from January 1,2007 to December 31,2011 were retrospectively analyzed.All 219 patients underwent radical resection and D2 lymph node dissection with transabdominal approach.All patients were followed up by telephone and outpatient.Kaplan-Meier method was used to draw the survival curve and calculate the survival rate.Log-rank test was used for univariate analysis.Cox proportional hazard regression model was used for multivariate analysis.RESULTS All 219 patients with Siewert typeⅡand typeⅢAEG were followed up after surgery.The follow-up time was 3-71 months,the median follow-up time was 60 months,and 68 patients died during the follow-up.The overall survival rates of 219 SiewertⅡandⅢAEG patients at 1,3,and 5 years after surgery were 91%,70%,and 55%,respectively.Univariate analysis showed that metastatic lymph node ratio(MLR,χ^2=65.070,P<0.001),pN stage(χ^2=50.724,P<0.001),TNM stage(χ^2=44.438,P<0.001),tumor size(χ^2=11.416,P=0.001),depth of invasion(χ^2=24.628,P<0.001),surgical method(χ^2=8.633,P=0.003),age(χ^2=4.476,P=0.034),CEA(χ^2=18.464,P<0.001)and CA199(χ^2=14.405,P<0.001)levels were related to patient prognosis.Multivariate analysis showed that MLR(HR=1.830,95%CI:1.353-2.477,P<0.001),pN stage(HR=1.681,95%CI:1.243-2.273,P=0.001),TNM stage(HR=1.865,95%CI:1.061-3.279,P=0.030)and CEA level(HR=1.807,95%CI:1.026-3.182,P=0.040)were independent risk factors that affected patients’prognosis.CONCLUSION MLR,pN stage,TNM stage and CEA level are independent risk factors that affect the prognosis of patients with

关 键 词：食管胃结合部腺癌 胃切除术 淋巴结清除 预后因素 多因素分析 

分 类 号：R735[医药卫生—肿瘤]