129例食管胃结合部小细胞癌的外科治疗及预后分析  

Surgery treatment and prognosis analysis of 129 small cell carcinoma of the esophagogastric junction

作　　者：李宝重 何明[2] 陈新[2] 朱辉[2] 徐新建[2] Li Baozhong;He Ming;Chen Xin;Zhu Hui;Xu Xinjian(Department of Thoracic Surgery,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Department of Thoracic Surgery,the Fourth Hospital,Hebei Medical University,Shijiazhuang 050011,China)

机构地区：[1]首都医科大学附属北京世纪坛医院胸部外科,100038 [2]河北医科大学第四医院胸外科,石家庄050011

出　　处：《中华肿瘤杂志》2021年第4期490-496,共7页Chinese Journal of Oncology

摘　　要：目的探讨食管胃结合部小细胞癌患者的外科治疗效果和预后影响因素。方法回顾性分析2004年1月至2010年12月于河北医科大学第四医院胸外科接受外科治疗的129例食管胃结合部小细胞癌患者的临床资料。单因素生存分析采用Kaplan-Meier法和Log rank检验,多因素生存分析采用Cox回归模型。结果129例患者中,行根治性近端胃切除术123例,姑息性切除术6例。全组患者的5年总生存率为21.0%,中位总生存时间为25.7个月,5年无进展生存率为11.0%,中位无进展生存时间为19.1个月。单因素分析显示,手术方式、是否根治性手术、肿瘤长径、TNM分期、淋巴结转移、脉管瘤栓、手术残端阳性、Syn的表达、综合治疗和疾病进展后放化疗均与患者的总生存有关(均P<0.05);多因素分析显示,淋巴结转移、疾病进展后放化疗是影响患者总生存的独立危险因素(均P<0.05)。单因素分析显示,手术方式、是否根治性手术、肿瘤长径、TNM分期、淋巴结转移、脉管瘤栓、手术残端阳性、Syn的表达、综合治疗和疾病进展后放化疗与患者的无进展生存有关(均P<0.05);多因素分析显示,淋巴结转移、疾病进展后放化疗是影响患者无进展生存的独立危险因素(均P<0.05)。结论食管胃结合部小细胞癌患者的预后较差,淋巴结转移、疾病进展后放化疗是影响患者预后的独立因素。Objective To analysis the prognosis related factors of patients with small cell cancer of the esophagogastric junction treated by surgery.Methods The clinicopathologic data of 129 patients with small cell cancer of the esophagogastric junction underwent surgery treatment in the Fourth Hospital of Hebei Medical University from January 2004 to December 2010 were retrospectively analyzed.Univariate survival survival was performed by Kaplan-Meier method and Log rank test.Multivariate survival was analyzed by using Cox proportional hazard model.Results Radical surgery was performed in 123 patients,whereas other 6 cases were conducted palliative operation.The 5-year overall survival(OS)rate of this cohort was 21.0%and median survival time was 25.7 months.The 5-year progression free survival(PFS)rate of this cohort was 11.0%and median PFS time was 19.1 months.The univariate analysis result showed that operation manner,radical or not,tumor length,lymph node metastasis,TNM stage,intravascular cancer embolus surgical margin positive or not,the expression of Syn,comprehensive treatment and radiochemotherapy after progression were associated with the OS of these patients(P<0.05).Multivariate analysis result showed that lymph node metastasis,radiochemotherapy after progression were independent risk factors of OS(P<0.05).Univariate analysis result showed that operation manner,radical or not,tumor length,TNM stage,lymph node metastasis,intravascular cancer embolus,surgical margin positive or not,the expression of Syn,comprehensive treatment and radiochemotherapy after progression were associated with PFS(P<0.05).Multivariate analysis showed that lymph node metastasis and radiochemotherapy after progression were independent risk factors of PFS(P<0.05).Conclusions The prognosis of small cell cancer of the esophagogastric junction patients remains poor.Lymph node metastasis and radiochemotherapy after progression are regarded as independent prognostic factors of these patients.

关 键 词：食管胃结合部肿瘤 小细胞癌 外科治疗 预后 生存分析 

分 类 号：R735[医药卫生—肿瘤]