217例食管胃交界癌病人术后生存分布及预后因素的回顾性研究

发布时间：2018-04-09 17:35

本文选题：食管胃交界癌　切入点：生存率　出处：《河北医科大学》2017年硕士论文

【摘要】：目的:食管胃交界癌是最常见的消化道恶性肿瘤之一,我国是世界上食管胃交界癌的高发地区之一,食管胃交界癌的诊治工作一直是我国医学研究的重点。目前手术切除是食管胃交界癌的主要治疗方法。鉴于此,本研究对河北医科大学第四医院东院胸外科2010年1月至2014年1月间行食管胃交界癌根治术的217例病人进行回顾性研究,分析术后的生存分布,研究影响生存的预后因素,以期待为制定更为精准的外科处理策略提供一定参考。方法:选取于我科行手术治疗的273例食管胃交界癌病人,对其进行术后调查随访,对符合入组条件的217例病人资料采用寿命表法进行生存分析,并绘制生存曲线,采用Cox比例风险模型进行多因素分析,将年龄、性别、手术方式、病理组织学类型、其分化程度G、浸润深度T、淋巴结清扫数目及阳性数目,作为协变量纳入检验。总结食管胃交界癌的最优手术方式。结果:1食管胃交界癌术后病人3、5年生存率分别为62%、50%,术后病人中位生存期为60个月,累积生存曲线可见Fig.1。2 Log-rank单因素分析结果表明:不同手术径路,肿瘤分化程度G,浸润深度T,有无腹腔淋巴结转移(尤其是胃左动脉旁淋巴结、贲门旁淋巴结、胃小弯淋巴结),残端是否阳性,术后是否发生复发或转移及术前胃镜判断肿瘤侵及齿线上距离是影响食管胃交界癌预后的因素;而年龄、有无心脑血管疾病及糖尿病、病理组织学类型、有无脉管瘤栓、纵隔淋巴结是否有转移(尤其是食管下段旁淋巴结是否转移)、术前胃镜示侵及胃的范围都不是影响食管胃交界癌预后的因素。详细数据见Table1。3 Cox比例风险模型多因素分析结果表明:在调整了入组的其他因素的混杂效应情况下,年龄、腹腔淋巴结是否发生转移、残端是否阳性、向上侵及食管长度及手术方式是影响食管胃交界癌预后的因素。而且,随着年龄增长,每增加1岁,食管胃交界癌病人术后死亡风险增加7%;腹腔淋巴结发生转移和残端阳性都是食管胃交界癌术后的危险因素;术前胃镜显示上侵及食管长度每增加1cm,相对应食管胃交界癌的病人术后死亡风险增加9%;不同手术径路中不同水平进行亚变量分析得出经腹部相对经胸部增加了术后病人的死亡系数。具体数据详见Table 2。结论:1经手术干预后食管胃交界癌病人的术后生存率有所提高,尤其是经胸的手术路径较经腹的术后生存率高。2对于年龄较大、腹腔淋巴结已发生转移、食管胃交界癌上侵食管的长度越长的病人,预后较差。
[Abstract]:Objective: esophageal and gastric borderline carcinoma is one of the most common malignant tumors of digestive tract in China. The diagnosis and treatment of esophagogastric borderline carcinoma has been the focus of medical research in China.At present, surgical resection is the main treatment of esophageal and gastric junction cancer.In view of this, 217 patients who underwent radical resection of esophageal and gastric junction cancer from January 2010 to January 2014 in the Department of Thoracic surgery, Eastern Hospital, fourth Hospital of Hebei Medical University, were retrospectively studied and their survival distribution was analyzed.To study the prognostic factors affecting survival and to provide some reference for the development of more accurate surgical management strategy.Methods: 273 patients with esophageal and gastric borderline carcinoma who were operated in our department were investigated and followed up after operation. 217 patients who met the condition of admission were analyzed by life table method and the survival curve was drawn.Cox proportional risk model was used for multivariate analysis. Age, sex, operation mode, histopathologic type, differentiation degree, depth of invasion, number of lymph node dissection and number of positive lymph nodes were included as covariate test.Objective: to summarize the optimal surgical methods of esophageal and gastric junction carcinoma.Results the 3- and 5-year survival rates were 620.The median survival time was 60 months. The cumulative survival curve showed Fig.1.2 Log-rank single factor analysis.Tumor differentiation degree G, depth of invasion, abdominal lymph node metastasis (especially left gastric artery lymph node, paracardial lymph node, small gastric curvature lymph node, whether the stump is positive or not.Recurrence or metastasis after operation and the distance between the invasion of the tooth line and the preoperative gastroscope were the factors influencing the prognosis of esophageal and gastric junctional carcinoma, while age, cardiovascular and cerebrovascular diseases and diabetes, histopathological type, and vascular embolus were found.The mediastinal lymph node metastasis (especially the paracentral lymph node metastasis of the lower esophagus, the range of preoperative gastroscopy and gastric invasion) were not the factors influencing the prognosis of esophageal and gastric junction carcinoma.The results of multivariate analysis of Table1.3 Cox proportional risk model showed that age, abdominal lymph node metastasis, and stump were positive in the case of adjusting for the confounding effect of other factors in the group.The length of esophagus and the operative mode were the factors influencing the prognosis of esophageal and gastric junction carcinoma.Preoperative gastroscopy showed that with an increase of 1 cm in the length of the esophagus, the risk of death in patients corresponding to esophagogastric borderline carcinoma increased by 9. Subvariable analysis at different levels in different operative paths showed that the transabdominal operation was increased relative to that of the chest.After the death coefficient of patients.For more details, see Table 2.Conclusion the postoperative survival rate of patients with esophageal and gastric junctional carcinoma increased after intervention, especially the survival rate of the patients with transthoracic surgery was higher than that of the patients with abdominal cancer. 2. For the older patients, the abdominal lymph nodes had been metastasized.The longer the length of the esophagus invades the esophagus, the worse the prognosis is.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735

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