pT1b-4aN0M0胸段食管鳞癌术后生存相关因素研究-现代医学

pT1b-4aN0M0胸段食管鳞癌术后生存相关因素研究

单位：1. 上海交通大学医学院附属仁济医院胸外科, 上海 200127;
2. 上海交通大学附属胸科医院胸外科, 上海 200030

分类号：R735.1

出版年·卷·期（页码）：2017·36·第八期（1088-1094）

摘要：

目的：探索pN0胸段食管鳞癌术后生存相关的临床高危因素，从而有针对性的进行术后辅助治疗，改善预后。方法：回顾性分析112例pT1b-4aN0M0胸段食管鳞癌术后生存情况，并用Cox回归分析方法分析临床病理学等相关因素与其关系。结果：全组患者1、3、5年总体生存率（OS）分别为97.3%、71.5%和62.3%，中位生存期为37个月（范围为5~121个月），术后1、3、5年无瘤生存率（DFS）分别为84.8%、64.7%和57.2%。Cox多因素分析发现肿瘤浸润深度T4a （HR 1.373，95%CI：1.047~1.801；P=0.022）、肿瘤低分化（HR 1.462，95%CI：1.053~2.031；P=0.023）、年龄≤ 50岁（HR 2.530，95%CI：1.126~5.684；P=0.025）是影响pT1b-4aN0M0患者术后OS的独立预后因素；肿瘤低分化（HR 1.614，95%CI：1.188~2.193；P=0.002）、年龄≤ 50岁（HR 2.684，95%CI：1.266~5.691；P=0.010）、肿瘤长度> 4 cm （HR 2.097，95%CI：1.136~3.870；P=0.018）是影响pT1b-4aN0M0患者术后DFS的独立预后因素。肿瘤病变长度与浸润深度（T分期）正相关（r=0.298，P=0.002）。结论：肿瘤细胞分化程度（低分化）及年龄（≤ 50岁）是pT1b-4aN0M0胸段食管鳞癌患者术后DFS、OS的独立预后因素，肿瘤长度（>4 cm）是患者术后DFS的独立预后因素，而肿瘤浸润深度（T4a）是患者术后OS的独立预后因素；肿瘤长度与肿瘤浸润深度关系密切。对具有上述高危因素的患者进行术后辅助治疗可能有助于改善预后。

Objective: To investigate the effect of clinicopathological variables on postoperative survival for patients with confined tumors (grade pT1b-4a) without lymph node metastases in thoracic esophageal squamous cell carcinoma (ESCC). Methods: 112 thoracic ESCC patients who had undergone radical surgical resection and been confirmed as pT1b-4aN0M0 enrolled in this study. Cox regression analysis was employed to identify the factors affecting the postoperative survival. Correlations between tumor length and other factors were surveyed. Results: In the groups, the overall 2-, 3-and 5-year survival rates were 97.3%, 71.5%, and 62.3%, respectively. The 2-, 3-and 5-year disease-free survival rates were 84.8%, 64.7%, and 57.2%, respectively. In multivariate analysis based on cox regression, T4a (HR 1.373, 95%CI:1.047-1.801; P=0.022), lower tumor differentiation (HR 1.462, 95%CI:1.053-2.031; P=0.023), and age ≤ 50 years(HR 2.530, 95%CI:1.126~5.684; P=0.025)affected overall survival term significantly. Lower tumor differentiation (HR 1.614, 95%CI:1.188-2.193; P=0.002), age ≤ 50 years (HR 2.684, 95%CI:1.266~5.691;P=0.010), tumor length>4 cm (HR 2.097, 95%CI:1.136~3.870;P=0.018) affected Disease-free survival significantly. There was a significant association between tumor length and T status (r=0.298, P=0.002).Conclusions: 1) T4a, Lower tumor differentiation, and age ≤ 50 years were the independent prognostic factors for overall survival. 2) Lower tumor differentiation, age ≤ 50 years, and tumor length>4 cm were the independent prognostic factors for disease-free survival. The great correlations of tumor length with depth of tumor invasion (T status) may account for its independent clinical value. Thoracic ESCC patients with the above high risk factors affecting postoperative survival should be treated with adjuvant therapy. Maybe it could improve the prognosis for these patients.

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