术前吸烟及饮酒状态对食管鳞状细胞癌术后复发和转移的影响  

Effects of smoking and drinking status before operation on recurrence and metastasis of esophageal squamous cell carcinoma

作　　者：朱建飞[1] 豆亚伟[1] 田伟[1] 戴云[1] 罗向晖[1] 陈耀华[1] 王宏涛[1] 李喆 ZHU Jianfei;DOU Yawei;TIAN Wei;DAI Yun;LUO Xianghui;CHEN Yaohua;WANG Hongtao;LI Zhe(Department of Thoracic Surgery,Shannxi Provincial People's Hospital,Xi'an,710068,P.R.China;Department of Hematology and Oncology,Yan’an People’s Hospital,Yan’an,716000,Shanxi,P.R.China)

机构地区：[1]陕西省人民医院胸外科,西安710068 [2]延安市人民医院肿瘤血液科,陕西延安716000

出　　处：《中国胸心血管外科临床杂志》2021年第2期219-224,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：吴阶平医学基金会临床科研专项基金支持项目(320.6750.17527)。

摘　　要：目的分析术前吸烟及饮酒状态对可手术食管鳞状细胞癌(鳞癌)患者预后的影响。方法回顾性分析2007~2016年在陕西省人民医院接受手术治疗的483例食管鳞癌患者的临床资料。男352例、女131例,中位年龄为64(37~80)岁。其中吸烟者311例,饮酒者172例。分析术前饮酒及吸烟状态与食管鳞癌患者的临床病理特征之间的关系。采用log-rank法和Cox风险回归分别进行单因素和多因素生存分析。结果术前吸烟状态与患者的肿瘤部位相关(P=0.030)。饮酒状态与肿瘤部位(P=0.001)、分化程度(P=0.030)、病理T分期(P=0.024)和病理N分期(P=0.029)有关。单因素生存分析显示吸烟状态并不影响食管癌患者的无病生存期(P=0.188)和总生存期(P=0.127)。但饮酒的食管鳞癌患者具有较差的无病生存期(29.37个月vs.42.87个月,P=0.009),多因素分析进一步证明饮酒状态是影响患者无病生存期的独立危险因素(RR=1.28,P=0.040)。在总生存期方面,饮酒同样会缩短患者的总生存时间达21.47个月(P=0.014),但多因素分析并没有得到阳性结果。结论术前饮酒与食管鳞癌患者的分期、分化程度等相关,是影响食管鳞癌术后复发和转移的独立危险因素。Objective To evaluate the effect of smoking and drinking status on the prognosis of patients with esophageal squamous cell carcinoma(ESCC).Methods The clinical data of 483 patients with ESCC who underwent surgical treatment in Shannxi Provincial People's Hospital from 2007 to 2016 were retrospectively analyzed.Among them,352 patients were male and 131 were female,with a median age of 64(37-80)years.There were 311 smokers and 172 drinkers.The relationship between preoperative drinking or smoking status and the clinicopathological characteristics of patients with ESCC was analyzed.Log-rank method and Cox risk regression were used to conduct univariate and multivariate survival analysis,respectively.Results The preoperative smoking status was related to the patient's tumor location(P=0.030).Drinking status was associated with tumor location(P=0.001),degree of differentiation(P=0.030),pathological T stage(P=0.024)and pathological N stage(P=0.029).Univariate survival analysis showed that smoking status did not affect the disease-free survival(DFS)(P=0.188)and overall survival(OS)(P=0.127)of patients with ESCC.However,patients who drank alcohol had worse PFS than non-drinking patients(29.37 months vs.42.87 months,P=0.009).It was further proved that alcohol consumption was an independent risk factor affecting patients'recurrence and metastasis by using multivariate analysis(RR=1.28,P=0.040).Alcohol consumption also reduced the OS of patients by 21.47 months(P=0.014),however,multivariate analysis did not yield significant results.Conclusion Preoperative drinking status is related to the stage and differentiation of patients with ESCC.It is an independent risk factor affecting the recurrence and metastasis of ESCC.

关 键 词：吸烟状态 饮酒状态 食管鳞癌 预后 手术 

分 类 号：R735.1[医药卫生—肿瘤]