术前检查右上纵隔淋巴结阴性的胸中下段食管癌经左右胸入路根治术后的生存分析

发布时间：2018-04-08 22:20

本文选题：食管癌　切入点：长期生存　出处：《北京协和医学院》2017年硕士论文

【摘要】：目的:食管癌是我国高发率和高死亡率的恶性肿瘤之一,目前,食管癌的主要治疗模式仍是以外科手术为主的综合治疗。食管癌的手术方式复杂多样,食管癌的手术入路主要为左胸入路和右胸入路。据目前文献报道右胸入路的术后生存相比左胸入路虽然有明显优势,但在右上纵隔淋巴结阴性的食管癌患者经两种入路治疗后的生存率无统计学上显著性差异。因此,目前对于术前检查未发现右上纵隔淋巴结肿大转移的胸中下段食管癌患者,入路选择尚无定论,还需要进一步的研究。方法:回顾性分析2011年中国医学科学院肿瘤医院行根治性食管癌切除+胸腹二野淋巴结清扫的胸中下段食管癌患者的临床资料403例,应用SPSS22.0和Stata14.0软件,应用Life-Table进行生存分析,应用倾向评分匹配(PSM)进行匹配分析,p值0.05为有显著性统计学差异。结果:经左、右胸入路治疗病例共403例,本组总的五年生存率为38%,其中左胸入路组共282例,五年生存率为37%,右胸入路组共121例,五年生存率为39%,P=0.908。两组之间生存率未见显著统计学差异。术前右上纵隔无转移的生存分析结果显示:左胸入路组共256例,五年生存率为38%,右胸入路组共88例,五年生存率为43%,P=0.404。左右胸不同入路组倾向评分匹配(PSM)后的生存分析结果:左胸入路组共110例,五年生存率为32%,右胸入路组共110例,五年生存率为40%,P=0.146。术前检查无右上纵隔淋巴结转移的左右胸不同入路组PSM后的生存分析结果:左胸入路组共88例,五年生存率为33%,右胸入路组共88例,五年生存率为44%,P=0.239。小结:对于胸中下段食管鳞癌,无论右上纵隔术前检查有无发现淋巴结转移,右胸入路较左胸入路均能够获得更好的总生存,但两组生存分析未见显著统计学差异。因此,目前对于术前检查无右上纵隔无淋巴结转移的患者是否仍可以采取左胸入路手术治疗尚需进一步的前瞻性随机对照研究来证实。
[Abstract]:Objective: esophageal cancer is one of the malignant tumors with high incidence and mortality in China.The surgical approaches of esophageal carcinoma are mainly left thoracic approach and right thoracic approach.It is reported that the survival rate of the right thoracic approach is significantly superior to that of the left thoracic approach, but there is no significant difference in survival rate between the two approaches in patients with esophageal cancer with negative right upper mediastinal lymph nodes.Therefore, for patients with middle and lower thoracic esophageal carcinoma whose right upper mediastinal lymphadenopathy and metastasis are not found by preoperative examination, there is no final conclusion on the choice of approach, and further study is needed.Methods: the clinical data of 403 patients with middle and lower thoracic esophageal carcinoma underwent radical resection of thoracic and abdominal second-field lymph nodes in 2011 were analyzed retrospectively. SPSS22.0 and Stata14.0 software were used to analyze the survival of patients with esophageal cancer. Life-Table was used to analyze the survival of esophageal carcinoma.There was significant statistical difference in P value (P 0.05) by using tendency score matching (PSM).Results: a total of 403 cases were treated by left and right thoracic approach. The overall 5-year survival rate was 380.908 in the left thoracic approach group (282 cases), the 5-year survival rate was 37% in the left thoracic approach group and 121 cases in the right thoracic approach group.There was no significant difference in survival rate between the two groups.The survival analysis of right superior mediastinum without metastasis before operation showed that there were 256 cases in the left thoracic approach group, 38 cases in the 5-year survival rate and 88 cases in the right thoracic approach group. The 5-year survival rate was 43% and 0.404% respectively.Results of survival analysis after PSM score matching in left and right thoracic approach group: there were 110 cases in the left thoracic approach group, 32 cases in the left thoracic approach group, and 110 cases in the right thoracic approach group, and the 5-year survival rate was 40% (P 0.146).Survival analysis of left and right thoracic approach groups without right superior mediastinal lymph node metastasis before operation: 88 cases in the left thoracic approach group and 88 cases in the right thoracic approach group. The 5-year survival rate was 33% in the left thoracic approach group and 0.239% in the right thoracic approach group.Conclusion: for middle and lower thoracic esophageal squamous cell carcinoma, whether or not lymph node metastasis was found in the right upper mediastinum before operation, the total survival of the right thoracic approach was better than that of the left thoracic approach, but there was no significant difference in survival analysis between the two groups.Therefore, further prospective randomized controlled studies are needed to confirm whether patients without lymph node metastasis in the right upper mediastinum can still be treated by left thoracic approach before operation.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.1

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