摘要目的 比较AJCC第7版与第8版食管癌分期系统对Ⅱ和Ⅲ期食管鳞状细胞癌患者术后预后的评估价值.方法 回顾性分析2006年1月至2010年12月在天津医科大学肿瘤医院食管肿瘤科接受手术切除的328例Ⅱ期和Ⅲ期食管鳞状细胞癌患者的临床病理资料.男性265例,女性63例,年龄33～87岁,中位年龄为65岁.应用Kaplan-Meier法进行生存分析,单因素Kaplan-Meier生存分析和多因素Cox比例风险模型确定预后因素.结果 无论是按照第7版还是第8版食管癌分期系统,Ⅱ和Ⅲ期食管鳞状细胞癌患者的5年生存率差异均有统计学意义(χ2=87.035、84.730,P值均=0.000).按照第7版食管癌分期系统,ⅡB和ⅢA期患者的5年生存率差异有统计学意义(39.6％比23.4％,P=0.001).按照第8版食管癌分期系统,ⅡA期和ⅡB期、ⅢB期和Ⅳ期患者的5年生存率差异有统计学意义(58.5％比35.5％,P=0.040;18.9％比0,P=0.000).多因素分析结果显示,肿瘤最大径(HR=1.592,95％CI:1.185～2.139,P=0.002)、分化类型(HR=1.404,95％CI:1.059～1.861,P=0.018)、T分期(HR=1.519,95％CI:1.236～1.867,P=0.000)、N分期(HR=1.647,95％CI:1.448～1.874,P=0.000)是本组食管鳞状细胞癌患者的独立预后因素.结论 第7版和第8版食管鳞状细胞癌TNM分期系统均能较好地预测食管鳞状细胞癌根治性切除术后患者的预后,肿瘤最大径、分化程度、浸润深度和区域淋巴结转移因素都是重要的独立预后因素.与第7版分期系统相比,第8版食管癌分期系统对于Ⅱ、Ⅲ期的划分更细致、更合理,对食管鳞状细胞癌患者术后的预后判断更准确.

abstractsObjective To compare and evaluate the prognostic value of the 7th and 8th edition of The AJCC Esophageal Cancer Staging System for patients with stage Ⅱ and Ⅲ esophageal squamous cell carcinoma. Methods The clinical data of 328 esophageal cancer patients who received operation at Department of Esophageal Cancer, Tianjin Tumour Hospital from January 2006 to December 2010 were restrospectively analyzed. There were 63 female and 265 male patients. The mean age was 65 ( range:33 to 87) years. Univariate and multivariate analysis were performed to identify the prognosis factors. Results The five years overall survival rates among patients with stage Ⅱ and Ⅲ were both significantly different (χ2=87. 035,84. 730,all P=0. 000) according to the 7th and 8th editions of the TNM staging systems. The five years overall survival rate among patients with stageⅡB andⅢA were significantly different ( 39. 6％ vs 23. 4％, P=0. 001) according to the 7th edition of the esophageal cancer staging systems. According to the 8th edition of the esophageal cancer staging system, the 5 years survival rate of patients with stage ⅡA and ⅡB, ⅢB and Ⅳ was statistically significant (58. 5% vs. 35. 5%, P =0. 040; 18. 9% vs. 0, P = 0. 000).In multivariate analysis, tumor size, T staging, N staging and tumor differentiation (HR =1. 592,95%CI: 1. 185 to 2. 139, P = 0. 002; HR = 1. 519, 95% CI: 1. 236 to 1. 867, P = 0. 000; HR =1. 647,95% CI: 1. 448 to 1. 874, P =0. 000; HR = 1. 404, 95% CI: 1. 059 to 1. 861, P = 0. 018) were the main independent prognosis factors affecting the prognosis of esophageal squamous cell carcinoma patients. Conclusions Both the 7th and the 8th editions of TNM staging systems are able to reflect the clinical prognosis of patients receiving radical resection of esophageal cancer, and the factors of tumor size,differentiaton, invasion depth and lymph node metastases are the independent predictors of prognosis. The 8th edition provides a more detailed and more reasonable for the staging of stage Ⅱ and Ⅲ for esophageal cancer patients than the 7th edition,and it is more accurate for the prognosis of patients with esophageal cancer after surgery.