浸润深度对接受左侧开胸手术的pT1期胸中段食管癌患者预后的影响  

The influence of depth of invasion on the prognosis of patients with pT1 mid-thoracic esophageal cancer undergoing left thoracotomy

作　　者：李曙光[1] 温晶媛 温士旺[1] 田子强[1] 祝淑钗[1] 沈文斌[1] Li Shuguang;Wen Jingyuan;Wen Shiwang;Tian Ziqiang;Zhu Shuchai;Shen Wenbin(Department of Radiotherapy,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China)

机构地区：[1]河北医科大学第四医院放射治疗科,石家庄050011

出　　处：《中华胸心血管外科杂志》2023年第11期653-659,共7页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨浸润深度对接受左侧开胸手术的pT1期胸中段食管癌患者预后的影响。方法回顾性分析139例符合入组条件的食管胸中段癌术后pT1N0M0期患者的临床病历资料。首先分析全组患者的预后及其影响因素,并比较pT1a期和pT1b期患者预后、局部区域复发和远处转移的差异,同时分析不同浸润深度对患者预后及治疗失败的影响。应用SPSS 25.0软件进行统计学分析。结果全组患者1、3、5年总生存率(OS)和无病生存率(DFS)分别为95.0%、87.8%、82.0%和91.4%、84.2%、77.0%。pT1a和pT1b期患者1、3、5年OS(χ^(2)=7.500,P=0.006)和DFS(χ^(2)=7.354,P=0.007)差异均有统计学意义。Cox多因素分析结果显示pT分期和病理类型为患者OS和DFS的独立性预后影响因素(P<0.05)。pT1a期肿瘤各不同浸润深度的OS(χ^(2)=0.734,P=0.693)和DFS(χ^(2)=0.7690,P=0.681)差异均无统计学意义;pT1b期肿瘤各不同浸润深度的1、3、5年OS(χ^(2)=15.368,P<0.001)和DFS(χ^(2)=27.470,P<0.001)差异均有统计学意义。pT1b期的复发率(23.8%)显著高于pT1a期(5.3%)患者(χ^(2)=5.274,P=0.022);前者的远处转移率(10.9%)亦显著性高于后者(0)(χ^(2)=4.494,P=0.034)。pT1b期患者不同浸润深度之间的局部区域复发率(χ^(2)=17.051,P<0.001)和远处转移率(χ^(2)=15.460,P<0.001)差异均有统计学意义。影响pT1b期患者治疗后失败的logistic多因素分析结果显示浸润深度为影响其出现局部区域复发的独立性因素(P<0.001);病理类型(P=0.003)和浸润深度(P=0.027)为影响其出现远处转移的独立性因素。结论pT1a期和pT1b期患者的预后及治疗后失败模式不尽相同,且pT1b期患者的不同浸润深度与患者的预后及其治疗后失败模式显著相关,浸润深度为影响pT1b期患者治疗后失败的独立性影响因素,建议临床医师应该重视pT1b期患者的术后辅助治疗。此结论需要大宗病例前瞻性研究结果证实。Objective To investigate the influence of the depth of invasion on the prognosis of pT1 stage mid-thoracic esophageal cancer patients undergoing left thoracotomy.Methods Retrospectively analyze the clinicopathological data of 139 patients with pT1N0M0 stage of mid-thoracic esophageal cancer who meet the enrollment criteria.Firstly,the prognosis and influencing factors of the whole group were analyzed.The differences in prognosis,local recurrence and distant metastasis between PT1A and PT1B patients were compared,and the influence of different infiltration depth on prognosis and treatment failure of patients was analyzed.SPSS 19.0 statistical software was used for statistical analysis.Results The 1-year,3-year and 5-year overall survival(OS)and disease-free survival(DFS)were 95.0%,87.8%,82.0%and 91.4%,84.2%,77.0%,respectively.There were significant differences in OS(χ^(2)=7.500,P=0.006)and DFS(χ^(2)=7.354,P=0.007)at 1,3 and 5 years between pT1a and pT1b patients.Cox multivariate analysis showed that pT stage and pathological type were independent prognostic factors for OS and DFS(P<0.05).There were no significant differences in OS(χ^(2)=0.734,P=0.693)and DFS(χ^(2)=0.7690,P=0.681)of pT1a tumors with different invasion depths.There were significant differences in OS(χ^(2)=15.368,P<0.001)and DFS(χ^(2)=27.470,P<0.001)at 1,3 and 5 years of pT1b tumors with different invasion depths.The recurrence rate of pT1b(23.8%)was significantly higher than that of pT1a(5.3%)(χ^(2)=5.274,P=0.022).The distant metastasis rate of the former(10.9%)was also significantly higher than that of the latter(0)(χ^(2)=4.494,P=0.034).There were significant differences in local recurrence rate(χ^(2)=17.051,P<0.001)and distant metastasis rate(χ^(2)=15.460,P<0.001)among pT1b patients with different infiltration depths.Logistic multivariate analysis showed that the depth of infiltration was an independent factor affecting the occurrence of local recurrence in stage pT1b patients after treatment(P<0.001).Pathological type(P=0.003)and infilt

关 键 词：食管肿瘤 手术治疗 浸润深度 预后 失败模式 

分 类 号：R735.1[医药卫生—肿瘤]