胸段食管鳞癌外科治疗及预后分析(附2766例报告)  

Surgical treatment and prognosis analysis of thoracic esophageal squamous cell carcinoma:a report of 2766 cases

作　　者：倪琨涵 李昌顶 姜龙琳 何文武 王程浩 王康宁[1] 刘光源[1] 彭林[1] 方强[1] 肖文光[1] 乔良 王奇峰[3] 韩泳涛[1] 冷雪峰 Ni Kunhan;Li Changding;Jiang Longlin;He Wenwu;Wang Chenghao;Wang Kangning;Liu Guangyuan;Peng Lin;Fang Qiang;Xiao Wenguang;Qiao Liang;Wang Qifeng;Han Yongtao;Leng Xuefeng(Department of Thoracic Surgery,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,Affiliated Cancer Hospital of University of Electronic Science and Technology of China(UESTC),Chengdu 610041,China;Department of Cancer Prevention and Treatment,Chengdu 610041,China;Department of Radiation Oncology,Sichuan Cancer Hospital&Institution,Sichuan Cancer Center,School of Medicine,University of Electronic Science and Technology of China,Chengdu 610041,China)

机构地区：[1]四川省肿瘤临床医学研究中心、四川省肿瘤医院·研究所、四川省癌症防治中心、电子科技大学附属肿瘤医院胸外科,成都610041 [2]四川省癌症防治中心办公室(预防部),成都610041 [3]放射肿瘤学四川省重点实验室、四川省肿瘤临床医学研究中心、四川省肿瘤医院·研究所、四川省癌症防治中心、电子科技大学附属肿瘤医院放疗科,成都610041

出　　处：《中华消化外科杂志》2023年第10期1199-1204,共6页Chinese Journal of Digestive Surgery

基　　金：国家重点研发计划(2022YFC2403400);四川省科技厅重点研发项目(2023YFS0044);四川省国际科技创新合作项目(2020YFH0169);四川省科技厅区域创新合作项目(2023YFQ0055,2023YFQ0056);四川省应用基础研究项目(2021YJ0118);吴阶平医学基金会临床科研专项资助基金(320.6750.2020-15-3);四川省临床重点专科建设项目。

摘　　要：目的探讨胸段食管鳞癌外科治疗及预后。方法采用回顾性队列研究方法。收集2010年1月至2017年12月四川省肿瘤医院收治的2766例胸段食管鳞癌患者的临床病理资料;男2256例,女510例;年龄为(62±8)岁。患者均行外科手术治疗。观察指标:(1)治疗情况。(2)术后并发症情况。(3)术后生存情况。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(Q1,Q3)表示。计数资料以绝对数或百分率表示。采用Kaplan-Meier法绘制生存曲线并计算生存率,Log-Rank检验进行生存分析。结果(1)治疗情况。2766例患者中,新辅助治疗52例;1444例行开放手术(其中44例中转开胸手术),1322例行微创食管切除术;手术方式为McKeown、Ivor-Lewis、Sweet分别为1991、729、46例;术后辅助治疗1271例。2766例患者淋巴结转移数目为2.1(0,3.0)枚,淋巴结清扫数目为(22±12)枚,R0切除率为94.722%(2620/2766),手术时间为(237±66)min。(2)术后并发症情况。2766例患者术后总并发症发生率为25.850%(715/2766),术后肺炎和吻合口瘘发生率最高,分别为8.604%(238/2766)和7.484%(207/2766)。同一例患者可合并≥2种术后并发症。(3)术后生存情况。2766例患者1、3、5年总生存率分别为86.2%、57.5%、46.8%。进一步分析,510例女性患者和2256例男性患者5年总生存率分别为62.0%和43.3%,两者比较,差异有统计学意义(χ^(2)=48.94,P<0.05)。693例胸上段、1479例胸中段、594例胸下段食管鳞癌患5年总生存率分别为49.5%、46.7%、44.1%,3者比较,差异无统计学意义(χ^(2)=3.21,P>0.05)。68例0期、259例Ⅰ期、885例Ⅱ期、1222例Ⅲ期、332例Ⅳ期患者5年总生存率分别为95.6%、76.4%、61.4%、35.6%、14.5%,5者比较,差异有统计学意义(χ^(2)=500.40,P<0.05)。1444例行开放手术和1322例行微创食管切除术患者5年总生存率分别为42.5%和51.8%,两者比较,差异有统计学意义(χ^(2)=31.29,P<0.05)。1991例行McKeown、729例行Ivor-Lewis、46�Objective To investigate the surgical treatment and prognosis of thoracic esophageal squamous cell carcinoma(ESCC).Methods The retrospective cohort study was conducted.The clinicopathological data of 2766 patients with thoracic ESCC who were admitted to Sichuan Cancer Hospital&Institute from January 2010 to December 2017 were collected.There were 2256 males and 510 females,aged(62±8)years.All patients underwent surgical treatment.Observation indicators:(1)treatment;(2)postoperative complications;(3)postoperative survival.Measurement data with normal distribution were represented as Mean±SD.Measurement data with skewed distribution were represented as M(Q1,Q3).Count data were described as absolute numbers or percentages.The Kaplan-Meier method was used to draw survival curve and calculate survival rate,and the Log-Rank test was used for survival analysis.Result(1)Treatment.Fifty-two of the 2766 patients underwent neoadjuvant therapy.There were 1444 patients undergoing open surgery,including 44 cases conversion to thoracotomy,and there were 1322 patients undergoing minimally invasive esophagectomy.There were 1991,729 and 46 cases with McKeown,Ivor-Lewis and Sweet esophagectomy,respectively.One thousand two hundred and seventy-one of the 2766 patients underwent postoperative adjuvant therapy.The number of lymph node metastases,the number of lymph node dissected,rate of R0 resection,operation time of 2766 patients were 2.1(0,3.0),22±12,94.722%(2620/2766),(237±66)minutes.(2)Postoperative complications.The overall incidence of postoperative complications was 25.850%(715/2766).The top two postoperative complications were pneumonia and anastomotic fistula,with incidence rates of 8.604%(238/2766)and 7.484%(207/2766),respectively.One patient may have more than two kinds of postoperative complications.(3)Postoperative survival.The 1-,3-and 5-year overall survival rates of 2766 patients were 86.2%,57.5%and 46.8%,respectively.Further analysis indicated that the 5-year overall survival rates of 510 female patients and 2256

关 键 词：食管肿瘤 鳞状细胞癌 微创食管切除术 开放手术 McKeown Ivor-Lewis SWEET 长期生存 

分 类 号：R735.1[医药卫生—肿瘤]