摘要目的:利用SEER数据库分析局限期可手术食管癌术前放化疗患者的预后及其相关因素,并建立生存预测列线图,为筛选术前放化疗患者提供一定参考.方法:选取SEER数据库2010-2015年食管癌接受术前放化疗且分期为T1b-4aNo.3Mo(2010年AJCC第7版分期)的病例;生存率采用Kaplan-Meier法,单因素分析采用Logrank检验,多因素分析采用Cox模型检验;通过R软件建立预测模型列线图;一致性指数(C-index)及校准曲线用来评价模型准确度.结果:共1 697例患者符合条件并可纳入分析.单因素分析显示性别、T分期、N分期、分化程度与总生存(OS)及癌症特异生存(CSS)均相关(P均＜0.001),年龄与OS相关(P=0.027).多因素分析显示年龄、性别、分化程度、N分期与OS相关;性别、分化程度、T分期、N分期与CSS相关(P均＜0.05).将预后相关因素纳入Nomogram预后模型,5年OS、CSS的C-index值分别为0.60、0.61.同样方法建立食管鳞癌亚组患者预后模型,OS及CSS的C-index值为0.62、0.64.结论:性别、临床分期、分化程度为局限期可手术食管癌行术前放化疗者CSS预后因素,根据以上数据建立的列线图可为是否采用术前放化疗联合手术治疗这一模式提供一定参考.

abstractsObjective The SEER database was utilized to analyze the prognosis and related factors for patients with locally resectable esophageal cancer undergoing preoperative chemoradiotherapy.A nomogram for predicting survival was established to provide reference for screening patients receiving preoperative chemoradiotherapy.Methods Patients diagnosed with stage T1b-4aN0-3M0(7th version AJCC in 2010) resectable esophageal cancer receiving preoperative chemoradiotherapy between 2010 and 2015 were selected from the SEER database.The survival rate was determined by Kaplan-Meier method.The univariate analysis was performed by log-rank test.The multivariate analysis was conducted by Cox test.The nomogram for survival prediction was established by using R software.The predicting accuracy of the nomogram was evaluated by C-index and calibration curve.Results A total of 1 697 eligible patients were included.Univariate analysis showed that sex,T stage,N stage and tumor differentiation were significantly associated with overall survival (OS) and cancer-specific survival rate (CSS)(all P＜0.001),and age (P=0.027) was significantly correlated with OS.Multivariate analysis demonstrated that age,sex,tumor differentiation and N stage were significantly associated with OS.Sex,tumor differentiation,T stage and N stage were significantly correlated with CSS (all P＜0.05).After the prognostic factors were included into the nomogram,the C-index for 5-year OS and CSS was 0.60 and 0.61.The model for predicting survival of patients with esophageal squamous cell cancer was established by using the same method.The C-index for the OS and CSS was 0.62 and 0.64.Conclusions Sex,clinical stage and tumor differentiation are prognostic factors of CSS in patients with locally resectable esophageal cancer undergoing preoperative chemoradiotherapy followed by surgery.The nomogram established according to the data above can provide certain reference for the selection of preoperative chemoradiotherapy combined with surgery.