摘要目的:分析食管鳞癌环周切缘情况与患者术后生存预后的关系，并探讨其与临床病理特征的相关性。方法:收集河北医科大学第四医院2017年10月至2019年3月行食管癌根治性切除术后的患者资料，所有患者临床资料完整，术后病理均为进展期鳞癌。采集并分析患者性别、年龄、T分期、N分期、肿瘤位置、病变长度、大体病理类型、脉管瘤栓、神经受侵、环周切缘等临床资料。按美国病理医师学会(College of American Pathologists，CAP)标准定义环周切缘阳性。按本研究入组标准共纳入328例，使用SPSS 20.0软件进行统计学分析，应用 Kaplan- Meier生存曲线及 Log- rank检验进行单因素生存分析，应用 Cox回归法进行多因素生存分析。计数资料采用 χ2检验和 Fisher精确检验分析。 结果:截至随访日期，全组328例食管鳞癌患者的1年和2年总生存率分别为91.9%和84.8%。总生存期中位值为16个月(2~25个月)。单因素分析显示，T分期、脉管瘤栓、神经受侵是总生存率的影响因素；多因素分析显示，神经受侵是影响总生存率的独立危险因素；分层分析显示，<60岁( P＝0.006)、大体病理类型为溃疡型( P＝0.002)、肿瘤长度≥4 cm的患者( P＝0.046)环周切缘情况与总生存率相关。全组患者的1年和2年无病生存率分别为89.7%和67.8%。无病生存期中位值为16个月(2~25个月)。单因素分析显示，N分期是食管鳞癌患者术后无病生存率的影响因素；分层分析显示，大体病理类型为溃疡型( P＝0.002)、肿瘤长度≥4 cm( P＝0.015)及环周切缘阴性组患者无病生存率优于环周切缘阳性组。全组环周切缘阳性患者66例，环周切缘阳性率为20.1%。单因素分析显示，T分期、N分期、脉管瘤栓、神经受侵、大体病理类型是环周切缘情况的影响因素；多因素 logistic回归分析显示，T分期、脉管瘤栓、大体病理类型是环周切缘情况的影响因素。 结论:应用CAP标准，未发现环周切缘对食管鳞癌的预后有影响。食管鳞癌环周切缘阳性与T分期、脉管瘤栓、大体病理类型相关，与其他临床病理特征不相关。

abstractsObjective:To analyze the relationship between the circumferential resection margin status and prognosis and clinicopathological features of esophageal squamous cell carcinoma.Methods:The information of esophageal squamous cell carcinoma patients who underwent radical resection at the Fourth Hospital of Hebei Medical University from October 2017 to March 2019 were collected. All patients were diagnosed with advanced squamous cell carcinoma by postoperative pathology. Demographic data including sex, age, T stage, N stage, tumor location, lesion length, gross pathological type, vascular tumor embolization, nerve invasion and circumferential resection margin were collected and analyzed. The circumferential resection margins were evaluated using the College of American Pathologists(CAP) criteria. A total of 328 cases were included in this study according to the inclusion criteria. Using SPSS 20.0 statistical software, univariate survival analysis was assessed by Kaplan- Meier survival curves, survival curves were compared using Log- rank tests, and multivariate analysis was carried out by Cox regression. The Fisher exact and Chi- square tests were used to compare counting data. Results:As of the follow-up date, the 1-year and 2-year overall survival rates of 328 patients with esophageal squamous cell carcinoma were 91.9% and 84.8%, respectively. The median overall survival was 16 months(range 2-25 months). Univariate analysis showed that T stage, vascular embolism and nerve invasion were the influencing factors of overall survival, multivariate analysis showed that nerve invasion was an independent risk factor for overall survival, stratified analysis showed that the circumferential resection margin was related to overall survival in patients less than 60 years old( P=0.006), patients with ulcerative type of gross pathology( P=0.002) and patients with tumor length ≥4 cm( P=0.046). The 1-year and 2-year disease-free survival rates of the whole group were 89.7% and 67.8%, respectively. The median disease-free survival was 16 months(range 2-25 months). Univariate analysis showed that N stage was the influencing factor of disease-free survival in patients with esophageal squamous cell carcinoma, and stratified analysis showed that the disease-free survival rate of patients with ulcerative type( P=0.002), tumor length ≥4 cm( P=0.015) and circumferential resection margin negative group were better than that of circumferential resection margin positive group. There were 66 patients with positive circumferential resection margin in the whole group, and the positive rate of circumferential resection margin was 20.1%. Univariate analysis showed that T stage, N stage, vascular embolism, nerve invasion and gross pathological type were the influencing factors of circumferential resection margin, while multivariate logistic regression analysis showed that T stage, vascular embolism and gross pathological type were the influencing factors of circumferential resection margin. Conclusion:According to CAP criteria, circumferential resection margin is not related to the prognosis of patients with esophageal squamous cell carcinoma.Positive circumferential resection margins of esophageal squamous cell carcinoma correlate with T stage, vascular embolism, and gross pathologic type, but not with other clinicopathologic features.