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胸段食管鳞状细胞癌外科治疗与预后分析

Surgical treatment and prognosis in patients with squamons cell carcinoma of thoracic esophagns

摘要:

目的 探讨胸段食管鳞状细胞癌切除术后生存率的影响因素.方法 回顾性分析1990年1月至1998年12月716例胸段食管鳞状细胞癌手术患者的临床病理资料,其中男性538例,女性178例;年龄24-78岁,中位年龄57岁.应用Kaplan-Meier法进行生存分析,组间比较用Logrank检验,采用COX模型进行多因素分析.结果 总的1、3、5和10年生存率分别为82.9%、44.3%、34.2%和25.7%.Ⅰ期、ⅡA期、ⅡB期和Ⅲ期患者的5年生存率分别为80.0%、51.2%、19.7%和13.3%.术后复发转移151例,占21.1%;其中ⅡA期、ⅡB期和Ⅲ期复发患者3年内复发率分别为84.2%、91.7%和90.O%.单因素分析表明性别、肿瘤浸润深度、淋巴结转移、病理分期、淋巴结转移区域数、组织分化、手术切缘和肿瘤复发均为预后影响因素.多因素分析显示肿瘤浸润深度、淋巴结转移、病理分期和肿瘤复发是食管癌预后的独立影响因素.结论 胸段食管鳞状细胞癌患者术后生存率的独立影响因素有肿瘤浸润深度、淋巴结转移、病理分期和肿瘤复发.手术是Ⅰ-ⅡA期食管癌的主要治疗方法,ⅡB-Ⅲ期食管癌应采用以手术为主的综合治疗.

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abstracts:

Objective To analyze the prognostic factors of thoracic esophageal squamous cell carcinoma(ESCC) after esophagectomy.Methods The clinicopathologic data of 716 patients with thoracic ESCC from January 1990 to December 1998 were analyzed retrospectively.There were 538 mule and 178 female patients aged from 24 to 78 years old with a median of 57 years old.Cumulative survival rate was analyzed by the Keplan-Meier method and compared by the Log-rank test.COX regression model was used for multivariate prognostic analysis.Results The overall 1-, 3-, 5- and 10-year survival rates were 82.9%,44.3%, 34.2% and 25.7% respectively.The 5-year survival rates was 80.0%, 51.2%, 19.7% and 13.3% for stage Ⅰ , stage Ⅱ A, stage Ⅱ B and stage Ⅲ respectively.Of the 716 patients, 151 (21.1%)patients recurred, including 48 (84.2% ) of stage Ⅱ A recurrence, 22 (91.7 % ) of stage ⅡB recurrence and 63 (90.0% ) of stage Ⅲ recurrence occurred within 3 years postoperatively.Univariate analysis revealed that the factors impacting the prognosis were gender, depth of invasion, lymph node metastasis, pathologic stage,number of lymph node metastatic field, differentiation, surgical margin and tumor relapse.Multivariate analysis showed that depth of invasion, lymph node metastasis, pathologic stage and tumor relapse were independently associated to poor prognosis.Conclusions Depth of invasion, lymph node metastasis,pathologic stage and tumor relapse are the independent factors of ESCC.Surgery is still the primary treatment for stage Ⅰ-Ⅱ A esophageal cancer; but it is suggested to adopt surgical treatment as primary modality combined with other therapies for stage Ⅱ B-Ⅲ esophageal cancer.

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