Ⅰ期食管鳞癌的生物学特征和外科治疗结果  

Biological characteristics and surgical treatment results of stageⅠesophageal squamous cell carcinoma

作　　者：张晓彬[1] 刘鹏 刘智超 杨洋[1] 李斌 孙益峰[1] 华荣[1] 郭旭峰[1] 何毅 顾海勇[1] 李志刚[1] ZHANG Xiao-bin;LIU Peng;LIU Zhi-chao;YANG Yang;LI Bin;SUN Yi-feng;HUA Rong;GUO Xu-feng;HE Yi;GU Hai-yong;LI Zhi-gang(Department of Thoracic Surgery-Esophageal Surgery,Shanghai Chest Hospital,Shanghai Jiao Tong University,Shanghai 200030,China;Department of Thoracic Surgery,the First People's Hospital of Ningyang County,Shandong Province,Ningyang 271400,China)

机构地区：[1]上海市胸科医院/上海交通大学附属胸科医院胸外科-食管外科,上海200030 [2]山东省泰安市宁阳县第一人民医院胸外科,宁阳271400

出　　处：《上海交通大学学报（医学版）》2021年第2期202-209,共8页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市教育委员会高峰高原学科建设计划(20181816)。

摘　　要：目的·回顾Ⅰ期食管鳞癌患者的外科治疗结果,分析此类早期肿瘤的临床生物学特征,并确定外科治疗是否是值得推荐的治愈性策略选择。方法·回顾性分析上海交通大学附属胸科医院2015年—2019年的379例Ⅰ期食管鳞癌外科患者临床资料。分期定义按照《美国癌症联合委员会分期手册》第8版确定。采用Kaplan-Meier法估计不同临床特征Ⅰ期食管鳞癌患者的生存情况,采用Log-rank检验比较各组生存率。并对年龄、性别、病理分期T、临床分期T、肿瘤直径、淋巴结清扫数等影响生存的指标进行单因素、多因素分析,评估影响预后的危险因素。结果·全组患者共379例,占同期所有接受食管癌根治术患者的11.9%。男性占79.2%。肿瘤在胸上、中、下段分布为14.2%、43.8%、42.0%。81.5%的患者采用了微创手术。R0切除率96.0%。淋巴结清扫数为(18.0±9.3)枚。术后并发症Clavien-Dindo分级Ⅲ级以上发生率为20.8%,其中吻合口瘘、喉返神经损伤、肺炎、呼吸功能不全的发生率分别为12.4%、14.2%、13.5%、2.9%。术后30 d内和90 d内死亡率分别为0.5%和1.3%。术后肿瘤病理显示T1a、T1b、T2比例为20.6%、69.4%、10.0%;术后病理肿瘤直径为(2.1±1.1)cm,小于术前内镜下肿瘤直径[(3.2±2.2)cm];淋巴管侵犯阳性率5.8%。随访时间为1~61个月,中位随访时间为24个月。随访期间,总体复发率为8.2%,局部区域复发率和远处转移率分别为7.4%和2.9%。单因素分析显示年龄、淋巴结清扫数与总体生存(overall survival,OS)相关(P=0.025,P=0.011),临床分期T、病理分期T、淋巴结清扫数与无病生存(disease-free survival,DFS)相关(P=0.017,P=0.005,P=0.001)。多因素分析显示OS的独立危险因素为年龄≥65岁、淋巴结清扫数少于15枚,DFS的独立危险因素为淋巴结清扫数少于15枚、临床分期为T2或T3。结论·Ⅰ期食管鳞癌患者经过以微创手术为主的外科治疗后,可以获得�Objectives·To review the results of surgical treatment for the patients with stageⅠesophageal squamous cell carcinoma,analyze the clinical biological characteristics,and determine whether surgical treatment is a recommended curative strategy.Methods·A total of 379 patients undergoing esophagectomy with stageⅠsquamous cell esophageal carcinoma from 2015 to 2019 in Shanghai Chest Hospital,Shanghai Jiao Tong University,were reviewed.The stage definition was determined according to the 8th edition of the American Joint Committee on Cancer(AJCC)cancer staging manual.Survival was calculated using the Kaplan-Meier method and was then compared by the Log-rank test.Univariate and multivariate analysis with the Cox proportional hazards model was used to investigate the effect of different factors on survival,including age,gender,pathological T stage,clinical T stage,tumor diameter,the number of dissected lymph nodes.Results·Three hundred and seventy-nine patients were included,accounting for 11.9%of all of patients undergoing esophagectomy during the same period.Male accounted for 79.2%.Tumors were located in the upper,middle,and lower segments of thoracic esophagus at 14.2%,43.8%,and 42.0%.A total of 81.5%of patients underwent minimally invasive surgery.The R0 resection rate was 96.0%.The average number of lymph node dissections was 18.0±9.3.The incidence of postoperative complications of the Clavien-Dindo gradeⅢor higher was 20.8%.The incidences of anastomotic fistula,recurrent laryngeal nerve injury,pneumonia,and respiratory insufficiency were 12.4%,14.2%,13.5%and 2.9%,respectively.The 30-d and 90-d mortality rates were 0.5%and 1.3%,respectively.Postoperative surgical pathology showed that T1a,T1b and T2 ratios were 20.6%,69.4%and 10.0%.The diameter of tumor in surgical sample was(2.1±1.1)cm,but larger in preoperative endoscopy evaluation[(3.2±2.2)cm],and the lymphovascular invasion rate was 5.8%.The follow-up time was 1 to 61 months,and the median follow-up time was 24 months.During the follow-up,the overal

关 键 词：食管鳞癌 早期食管癌 生物学特征 食管癌根治术 生存 

分 类 号：R655.4[医药卫生—外科学]