食管癌治疗后早期和晚期死亡的预测因素  

Predictors of early and advanced death after treatment for esophageal cancer

作　　者：王志新 周波 孙培胜[3] 郭明洲 WANG Zhixin;ZHOU Bo;SUN Peisheng;GUO Mingzhou(Department of Gastroenterology,the Third Affiliated Hospital of Xinxiang Medical University,Xinxiang 453000;Department of Gastroenterology&Hepatology,the First Medical Center,Chinese PLA General Hospital;Department of Gastrointestinal Surgery,the First Affiliated Hospital of Xinxiang Medical University,China)

机构地区：[1]新乡医学院第三附属医院消化内科,河南新乡453000 [2]中国人民解放军总医院第一医学中心消化内科医学部 [3]新乡医学院第一附属医院胃肠外科

出　　处：《胃肠病学和肝病学杂志》2022年第6期638-647,共10页Chinese Journal of Gastroenterology and Hepatology

基　　金：国家重点研发计划(2018YFA0208902,2020YFC2002705);国家自然科学基金委员会资助项目(81672318,U1604281);北京市自然科学基金重点项目(7171008);国家重点科学仪器专项计划(2011YQ03013405)。

摘　　要：目的阐明早期和晚期死亡的危险因素,为食管癌预后的预测提供依据。方法纳入2007年1月1日至2017年12月31日在新乡医学院第一附属医院和新乡医学院第三附属医院收治的食管癌确诊患者。收集相关的临床资料、病理资料及随访资料。运用单因素和多因素Cox回归对各变量进行分析,探究食管癌早期和晚期死亡的危险因素,并对相关危险因素进行生存分析。结果共有1310例患者纳入分析中,根据生存时间共分为三组,>60个月为存活组,共516例(39.4%),<36个月为早期死亡组,共650例(49.6%),36~60个月为晚期死亡组,共144例(11.0%)。将早期死亡组和存活组进行比较,单因素和多因素Cox回归分析提示,性别、年龄、饮酒史、上消化道炎症史、淋巴结转移、远处转移、肿瘤分期、肿瘤分化、肿瘤位置和治疗方式是早期死亡的独立危险因素。将晚期死亡组和存活组进行比较,单因素和多因素Cox回归分析提示,性别、年龄、主诉、上消化道炎症史、淋巴结转移、远处转移、肿瘤分期、肿瘤分型和治疗方式是晚期死亡的独立危险因素。结论早期死亡特有的危险因素包括饮酒史、肿瘤分化和肿瘤位置,晚期死亡特有的危险因素包括主诉和肿瘤分型。性别、年龄、上消化道炎症史、淋巴结转移、远处转移、肿瘤分期和治疗方式是早期死亡和晚期死亡共同的独立危险因素。以上结果提示食管癌早期和晚期死亡的危险因素不全相同,在临床上需要对早期和晚期死亡进行分别预测。Objective To elucidate the risk factors for early and advanced death of esophageal cancer,and to provide basis for the prediction of prognosis of esophageal cancer.Methods Patients diagnosed with esophageal cancer in the First Affiliated Hospital of Xinxiang Medical University and the Third Affiliated Hospital of Xinxiang Medical University from Jan.1st,2007 to Dec.31st,2017 were enrolled.Relevant clinical data,pathological data and follow-up data were collected.Univariate and multivariate Cox regression were used to analyze the risk factors of early and advanced death for esophageal cancer,and survival analysis was conducted for the related risk factors.Results A total of 1310 patients were included in the analysis.They were divided into 3 groups according to the survival time:516 cases(39.4%)in the survival group were more than 60 months,650 cases(49.6%)in the early death group were less than 36 months,and 144 cases(11.0%)in the advanced death group were 36-60 months.Compare the early death group with the survival group,sex,age,drinking history,history of upper gastrointestinal inflammation,lymph node metastasis,distant metastasis,tumor stage,tumor differentiation,tumor location and treatment were independent risk factors for early death.Compare the advanced death group with the survival group,sex,age,chief complaint,history of upper gastrointestinal inflammation,lymph node metastasis,distant metastasis,tumor stage,pathological classification and treatment were independent risk factors of advanced death.Conclusion Specific risk factors for early death include drinking history,tumor differentiation,and tumor location.Specific risk factors for advanced death include chief complaint and pathologic classification.Sex,age,history of upper gastrointestinal inflammation,lymph node metastasis,distant metastasis,tumor stage and treatment are independent risk factors for both early and advanced death.These results suggest that the risk factors of early and advanced death from esophageal cancer are not the same,and early

关 键 词：食管癌 早期死亡 晚期死亡 预测因素 

分 类 号：R735.1[医药卫生—肿瘤]