天津医药

天津医药 ›› 2020, Vol. 48 ›› Issue (3): 209-215.doi: 10.11958/20192423

• 临床研究 • 上一篇    下一篇

Ⅱ~Ⅲ期食管癌根治性切除术后患者预后的影响因素分析

宋春洋，祝淑钗，沈文斌 ，高丝娜 ，苏景伟，李娟，赵彦，许金蕊，李曙光，刘志坤   

  1. 1河北石家庄，河北医科大学第四医院放疗科（邮编 050011）；2石家庄市第三医院肾内科
  • 收稿日期:2019-08-13 修回日期:2019-11-29 出版日期:2020-03-15 发布日期:2020-04-11
  • 通讯作者: 祝淑钗 E-mail:sczhu1965@163.com

Influence factors for prognosis of stage Ⅱ-Ⅲ esophageal carcinoma patients treated with radical esophagectomy

SONG Chun-yang,ZHU Shu-chai,SHEN Wen-bin,GAO Si-na，SU Jing-wei,LI Juan,ZHAO Yan,XU Jin-rui,LI Shu-guang,LIU Zhi-kun   

  1. 1 Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011,China; 2 Department of Nephrology, the Third Hospital of Shijiazhuang
  • Received:2019-08-13 Revised:2019-11-29 Published:2020-03-15 Online:2020-04-11

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摘要：

目的 探讨影响Ⅱ~Ⅲ期食管癌根治性切除术后患者预后的因素。方法 回顾性分析 2007年 1月—2010年 12月行食管癌根治性切除术且术后病理分期为Ⅱ~Ⅲ期共 716例患者的临床资料。选择可能影响预后的临床病理资料及术后治疗情况进行单因素和多因素分析。结果 716 例患者 1、3、5 年总生存率分别为 79.85%、58.27%、
49.73%。多因素分析显示：性别、术中粘连程度、术后阳性淋巴结数目、T分期及术后辅助治疗是影响患者总生存时间（OS）的独立预后因素（均 P＜0.05）。对术后辅助治疗方式进行分层分析显示：Ⅱa期（342例）患者术后化疗组 OS优于单纯手术组和术后放疗组（χ2分别为 9.301、4.422，P＜0.05或P＜0.01）；Ⅱb（75例）及Ⅲ期（299例）患者术后放化疗组及术后放疗组 OS均优于单纯手术组（Ⅱb期：χ2分别为 3.926、4.605，P＜0.05；Ⅲ期：χ2分别为 8.504、7.435，P＜0.01）。716例患者 1、3、5年无进展生存率分别为 71.23%、49.32%、38.26%。多因素分析显示：性别、术中粘连程度、TNM分期及术后辅助治疗是影响患者无进展生存时间（PFS）的独立预后因素（均P＜0.05）。对术后辅助治疗方式进行分层分析显示：Ⅱa期患者术后化疗组 PFS优于单纯手术组（χ2=7.481，P＜0.01）；Ⅱb及Ⅲ期患者术后放化疗组 PFS均优于单纯手术组（χ2分别为 6.684、5.741，P＜0.05）。结论 根治术后辅助治疗为影响Ⅱ~Ⅲ期食管癌患者预后的重要因素。Ⅱa期患者可仅行术后化疗，而Ⅱb～Ⅲ期患者接受辅助放疗或放化疗可获得更优预后。

关键词: 食管肿瘤, 食管切除术, 放射疗法, 抗肿瘤联合化疗方案, 预后

Abstract: Objective To investigate the prognostic factors of patients with stage Ⅱ-Ⅲesophageal carcinoma after radical esophagectomy. Methods The clinical data of 716 patients with stage Ⅱ-Ⅲ esophageal carcinoma after radical surgery from 2007 to 2010 were retrospectively analyzed. Univariate analysis was performed by log-rank test, and multivariate analysis was performed by a Cox regression model. Results The 1-, 3- and 5-year overall survival rates were 79.85%, 58.27% and 49.73%, respectively. Multivariate analysis showed that gender, adhesion degree in operation, number of positive lymph nodes, T stage and postoperative adjuvant therapy were independent factors for overall survival (OS) (all P＜0.05). The patients with stage Ⅱa (n=342) obtained better OS in postoperative chemotherapy group compared with that of operation group and postoperative radiotherapy group (χ2=9.301 and 4.422,respectively, P＜0.05 or P＜0.01). The patients with stage Ⅱ b (n=75) and Ⅲ (n=299) obtained better OS in postoperative chemoradiotherapy group and postoperative radiotherapy group compared with that of operation group (Ⅱb:χ2=3.926 and 4.605,respectively, P＜0.05; Ⅲ:χ2=8.504 and 7.435, respectively, P＜0.01). The 1- , 3- and 5-year progression-free survival rates were 71.23%, 49.32% and 38.26%, respectively. Multivariate analysis showed that gender, adhesion degree in operation, TNM stage and postoperative adjuvant therapy were independent factors for progression-free survival (PFS) (all P＜0.05). The patients with stage Ⅱ a obtained better PFS in postoperative chemotherapy group compared with that of operation group (χ2=7.481, P＜0.01). The patients with stage Ⅱb andⅢobtained better PFS in postoperative chemoradiotherapy group compared with that of operation group(χ2=6.684 and 5.741, respectively, P＜0.05). Conclusion Postoperative adjuvant therapy is important for the prognosis of stage Ⅱ - Ⅲ esophageal cancer patients after radical esophagectomy. Patients with stage Ⅱ a treated with postoperative chemotherapy and stage Ⅱb-Ⅲtreated with adjuvant radiotherapy or chemoradiotherapy can obtain better prognosis.

Key words: esophageal neoplasms, esophagectomy, radiotherapy, antineoplastic combined chemotherapy protocols, prognosis