摘要
目的分析pT 1胸段食管鳞状细胞癌(thoracic esophageal squamous cell carcinoma)患者术后疗效及复发转移的危险因素,探讨pT 1食管癌术后的治疗方案。方法收集131例pT 1胸段食管鳞状细胞癌患者的病理和临床资料。采用SPSS 21. 0统计学软件进行统计分析。结果截止2018年1月,共有34例(25. 95%)患者死亡,27例死于肿瘤本身,另外有7例死于其他原因。随访期间出现28例(21. 4%)局部复发和(或)远处转移,其中局部-区域性复发15例(11. 45%),远处转移9例(6. 87%),出现局部区域性复发合并远处转移4例(3. 05%)。全组患者的1、3、5年的总生存时间(OS)率和无进展生存率(PFS)分别为96. 9%和90. 8%、86. 3%和80. 2%、71. 0%和69. 5%。单因素分析显示淋巴结转移、脉管瘤栓、浸润深度和嗜酒史是pT 1食管癌根治术后患者出现复发转移的独立危险因素(P <0. 05);多因素分析发现脉管瘤栓和嗜酒史是本组pT 1食管鳞癌患者术后出现局部复发和(或)远处转移的独立危险因素(P <0. 05)。Kaplan-Meier法分析提示淋巴结转移、脉管瘤栓、嗜酒史、肿瘤长度> 2. 0 cm为术后PFS和OS的独立危险因素(P <0. 05);多因素COX回归分析提示脉管瘤栓、肿瘤长度> 2. 0 cm、肿瘤低分化程度、嗜酒史是pT 1食管鳞癌术后影响PFS和OS的独立危险因素(P <0. 05);肿瘤长度和嗜酒史是pT 1N0食管鳞癌术后PFS和OS的独立危险因素。结论在pT 1期胸段食管鳞癌根治术后仍有21. 4%患者出现局部复发和(或)远处转移,浸润深度、肿瘤长度、淋巴结转移、肿瘤分化程度、脉管瘤栓及嗜酒史是影响其治疗效果的危险因素。这部分患者术后应该制定更加密集的随访策略,而适当的术后辅助治疗或有助于降低术后复发转移风险及改善预后。
Objective Retrospective analysis of prognosis,recurrence and metastasis after treatment of significance and operation assisted radical postoperative stage pT 1 squamous cell carcinoma of thoracic esophagus. Methods 131 cases of stage pT 1 thoracic esophageal cancer which were diagnosized and treated with radical resection. SPSS 21. 0 statistical software was used to statistical analysis. Results The end of follow-up was January,2018. During the follow-up period,34（ 25. 95%） patients died,27 died from the tumor itself,and 7 died from other causes. 28 cases（ 21. 4%） was local recurrence and/or distant metastasis,which including 15 cases（ 11. 45%） of local regional recurrence,9 cases（ 6. 87%） of distant metastasis and 4 cases（ 3. 05%） of local regional recurrence combination of distant metastasis. The 1-,3-,5-year overall survival（ OS） rates were 96. 9%,90. 8%,86. 3%,respectively; the 1-,3-,5-year rates of progression free survival（ PFS） were 80. 2%,71. 0%,69. 5%,respectively. Univariate analysis showed lymphatic metastasis,vascular invasion,depth of invasion and drinking were the independent risk factors for local recurrence and（ or） distant metastasis in patients with pT 1 esophageal squamous carcinoma（ P〈0. 05）,with multivariate analysis,vascular invasion and drinking were the independent risk factors for local recurrence and（ or） distant metastasis in patients with pT 1 esophageal squamous carcinoma（ P〈0. 05）. The Kaplan-Meier method remind lymphatic metastasis,vascular invasion,drinking and tumor size（ 〉2. 0 cm） were the independent risk factors for OS and PFS（ P〈0. 05）; COX＇S regression model remind vascular invasion,drinking,tumor size（ 〉2. 0 cm）,differentiation degree and tumor length were theindependent risk factors for OS and PFS（ P〈0. 05）. Conclusion For patients of stage pT 1 squamous cell carcinoma of thoracic esophagus after radical resection,there were still 21. 4% of patients with local recurrence and/or distant metastasis. Postoperative pathology indicated that the tumor length 〉2. 0 cm,lymph node metastasis,infiltration depth of the submucosa,differentiation degree,the vascular invasion and drinking patients were associated with treatment failure. This group of patients should develop more intensive follow-up strategies after surgery,and appropriate post-operative adjuvant treatment may help reduce the risk of recurrence and improve prognosis after surgery.
作者
彭凯明
林济红
余绍斌
陈舒晨
韩子阳
陈明端
康明强
PENG Kaiming;LIN Jihong;YU Shaobin(Department of Thoracic Surgery,Fujian Medical University Union Hospital,Fuzhou 350001,China)
出处
《临床外科杂志》
2018年第9期657-661,共5页
Journal of Clinical Surgery
关键词
pT1食管鳞癌
食管癌根治术
复发
转移
辅助治疗
pT1 Esophageal squamous cell carcinomas
radical operation of esophageal cancer
recurrence
metastasis
adjuvant therapy
