胸段食管鳞状细胞癌术后淋巴结转移患者预后影响因素及治疗策略分析  

Analysis of prognostic influencing factors and treatment strategies of patients with LN metastasis after thoracic esophageal squamous cell carcinoma resection

作　　者：李学灿[1] 别志强[1] 李晓辉[1] LI Xuecan;BIE Zhiqiang;LI Xiaohui(Department of Cancer Surgery,People's Hospital of Jiaozuo City,Henan Jiaozuo 454002,China.)

机构地区：[1]焦作市人民医院肿瘤外科,河南焦作454002

出　　处：《现代肿瘤医学》2021年第12期2066-2071,共6页Journal of Modern Oncology

摘　　要：目的:探讨胸段食管鳞状细胞癌术后淋巴结(lymph node,LN)转移患者预后影响因素及治疗策略。方法:回顾性分析我院2008年1月-2014年3月收治的胸段食管鳞状细胞癌根治术后LN转移患者共411例临床资料,对预后影响因素进行单因素和多因素分析,进一步采用倾向性得分匹配法配对后确定最佳治疗策略。结果:入选患者随访1、3及5年累积总生存率分别为81.09%、40.66%、28.14%;随访1、3及5年累积无进展生存率分别为70.54%、41.20%、33.27%;中位总生存时间和无进展生存时间分别为27.0个月[(24.5~31.0)个月]、23.0个月[(21.0~27.0)个月]。单因素分析结果显示,性别、年龄、肿瘤长度、T分期、N分期及治疗策略与术后LN转移患者总生存时间有关(P<0.05);性别、T分期、N分期及治疗策略与术后LN转移患者无进展生存时间有关(P<0.05)。多因素分析结果显示,性别、年龄、肿瘤位置、T分期、N分期及治疗策略均是术后LN转移患者总生存时间独立影响因素(P<0.05);性别、肿瘤位置、T分期及N分期均是术后LN转移患者无进展生存时间独立影响因素(P<0.05)。将上述总生存和无进展生存可能影响因素纳入倾向性得分匹配法配对分析结果显示N分期和治疗策略是术后LN转移患者总生存时间和无进展生存时间独立影响因素(P<0.05)。倾向性得分匹配法配对分析显示,术后辅助放疗和术后辅助化疗患者总生存率均显著高于单纯手术者(P<0.05);术后辅助放化疗患者总生存率和无进展生存率均显著高于单纯手术、术后辅助放疗及术后辅助化疗者(P<0.05);同时N1期患者总生存率和无进展生存率均显著高于N2、N3期(P<0.05)。结论:淋巴结转移个数和治疗策略与胸段食管鳞状细胞癌根治术后LN转移患者远期预后密切相关;术后放化疗应作为首选辅助方案以期进一步改善患者生存获益。Objective:To investigate the prognostic influencing factors and treatment strategies of patients with LN metastasis after thoracic esophageal squamous cell carcinoma resection.Methods:Clinical data of 411 patients with LN metastasis after thoracic esophageal squamous cell carcinoma resection were retrospectively chosen in the period from January 2008 to March 2014 in our hospital.Univariate and multivariate analysis of prognostic factors were carried out,and the optimal treatment strategy was determined by matching the prognostic factors with propensity score matching method.Results:The cumulative overall survival rates for 1,3 and 5 years were respectively 81.09%,40.66%and 28.14%.The cumulative progression-free survival rates for 1,3 and 5 years were respectively 70.54%,41.20%,33.27%.The median total survival time and progression-free survival time were respectively 27.0 months[(24.5~31.0)months],23.0 months[(21.0~27.0)months].Univariate analysis showed that gender,age,tumor length,T stage,N stage and treatment strategy were related to the overall survival time of patients with LN metastasis after operation(P<0.05).Gender,T stage,N stage and treatment strategy were related to the progression-free survival time of patients with LN metastasis after operation(P<0.05).Multivariate analysis showed that gender,age,tumor location,T stage,N stage and treatment strategy were independent influencing factors for overall survival time of patients with LN metastasis after operation(P<0.05).The gender,tumor location,T stage and N stage were independent influencing factors for progression-free survival time of patients with LN metastasis after operation(P<0.05).Analysis results for including the above-mentioned factors of total survival and progression-free survival into the propensity score matching matching pair showed that N stage and treatment strategy were independent influencing factors of total survival time and progression-free survival time of patients with LN metastasis after operation(P<0.05).Propensity score matchi

关 键 词：食管鳞状细胞癌 手术 淋巴结 预后 

分 类 号：R735.1[医药卫生—肿瘤]