pN0期食管癌术后生存和复发的影响因素

发布时间：2018-06-09 13:22

本文选题：食管肿瘤/pN0期 + 分期/pT1-3N0M0　；参考：《河北医科大学》2017年硕士论文

【摘要】：第一部分pN0期食管癌术后的预后因素目的:探讨pN0期食管癌术后的预后相关因素及术后辅助治疗价值。方法:收集2008年1月至2012年12月行食管癌切除术、术后病理pN0期、术后生存期≥1月的1250例胸段食管癌患者资料。其中男性828例,女性422例;中位年龄61岁,范围在31岁~86岁之间。311例术前CT有直径1cm纵隔小淋巴结;采用两野手术者1214例,三野手术者36例;肿瘤位于胸上段167例、胸中段863例、胸下段220例;食管肿瘤中位长度5cm(范围0.2~14cm);术中粘连程度:无粘连者120例、轻度粘连者563例、重度粘连者415例、粘连程度记录不详者152例;吻合口位置:颈部157例、胸膜顶62例、主动脉弓上907例、主动脉弓下124例;术中清扫淋巴结中位数9枚(范围0~35枚);术后病理类型:中高分化鳞癌1042例,低分化鳞癌121例,非鳞癌87例;术后病理T分期:pT1期185例、pT2期276例、pT3期755例、pT4期34例。13例行术前化疗;单纯手术者588例,622例接受术后辅助性治疗,其中辅助性放疗49例、化疗547例、放化疗66例。采用SPSS 21.0统计学软件进行统计分析。结果:随访截止日期为2016年12月1日;全组患者失访17例,随访率为98.64%。有450例出现肿瘤进展,其中局部区域性复发占23.0%(287/1250)、远处转移占8.2%(102/1250)、局部区域性复发合并远处转移占4.9%(61/1250)。全组术后1、3、5年总生存率(OS)分别为92.7%、72.6%、62.1%;单因素分析,性别、年龄、肿瘤位置、纵隔小淋巴结、手术方式、术中粘连程度、清扫淋巴结数目、术后病理类型、残端阳性与否、脉管瘤栓、pT分期、术后辅助治疗均与pN0期食管癌术后OS有关(P0.05);多因素分析,性别、年龄、肿瘤位置、纵隔小淋巴结、术中粘连程度、清扫淋巴结数目、术后病理类型、pT分期、术后辅助治疗是影响pN0期食管癌术后OS的独立因素。全组术后1、3、5年无进展生存率(PFS)分别为83.8%、63.9%和56.9%;单因素分析显示,性别、年龄、纵隔小淋巴结、肿瘤位置、手术方式、术中粘连程度、清扫淋巴结数目、术后病理类型、残端阳性与否、脉管瘤栓、pT分期、术后辅助治疗与PFS相关(P0.05);多因素分析显示,年龄、肿瘤位置、纵隔小淋巴结、术中粘连程度、清扫淋巴结数目、术后病理类型、pT分期、术后辅助治疗是影响pN0期食管癌术后PFS的独立危险因素。单纯手术者1、3、5年OS分别为89.5%、69.7%、59.1%,术后放疗者1、3、5年OS分别为83.7%、59.2%、39.6%,术后化疗者1、3、5年OS分别94.3%、76.6%、68.4%;单纯手术、术后放疗、术后化疗者1、3、5年PFS分别80.9%、62.2%、55.2%,71.4%、44.9%、34.3%,87.8%、68.7%、62.5%。术后化疗与单纯手术比较能提高OS和PFS(P0.05),而术后放疗OS和PFS明显低于单纯手术(P0.05);但术后放疗组与单纯手术组比较pT分期晚、术中重度粘连者比例高(P0.05)。结论:pN0期胸段食管癌术后,女性、年龄轻、胸中下段癌、术前CT纵隔无小淋巴结、清扫淋巴结数目较多、术中粘连程度较轻、pT分期早、中高分化鳞癌、术后辅助化疗者预后较好,而男性、年龄较大、胸上段癌、术前CT纵隔有小淋巴结、清扫淋巴结数目较少、术中粘连程度较重、pT分期晚、低分化鳞癌或非鳞癌、单纯手术者预后较差;术后放疗的作用有待证实。第二部分pT1-3N0M0期胸段食管鳞癌根治术后复发规律目的:回顾性分析pT1-3N0M0期胸段食管鳞癌两野根治术后的复发规律。方法:收集2008年1月至2012年12月行食管癌根治性切除术(R0)、术后病理pT1-3N0M0期、术后生存期≥3个月的488例胸段食管鳞癌患者资料。其中男性303例,女性185例;年龄34~86岁,中位年龄62岁。肿瘤位于胸上段61例、胸中段344例、胸下段83例;pT分期:pT1期102例,pT2期126例,pT3期260例。采用SPSS 21.0统计学软件进行统计分析。结果:随访截止日期为2016年12月1日。pT1-3N0M0期胸段食管鳞癌根治术后的总复发率为36.9%(180/488),局部区域复发率为21.5%(105/488)、远处转移率为6.8%(33/488)、局部区域复发合并远处转移率为8.6%(42/488);卡方检验结果显示,肿瘤位置、清扫淋巴结数目、术前CT纵隔小淋巴结和pT分期与pT1-3N0M0期胸段食管鳞癌根治术后的总复发有关(P0.05);Logistic多因素分析显示,肿瘤位置、清扫淋巴结数目、术前CT纵隔小淋巴结和pT分期是影响术后总复发的独立危险因素。pT1-3N0M0期胸段食管鳞癌根治术后的总局部区域复发率为30.1%(147/488),颈部、纵隔、腹腔复发分别占总局部区域复发的21.1%(31/147)、80.3%(118/147)、7.5%(11/147);卡方检验结果显示,肿瘤位置、术前CT纵隔小淋巴结、pT分期与pT1-3N0M0期胸段食管鳞癌根治术后的局部区域复发有关(P0.05);Logistic多因素分析显示,肿瘤位置、清扫淋巴结数目、pT分期是影响术后局部区域复发的独立危险因素。结论:pT1-3N0M0期胸段食管鳞癌根治术后复发率较高,主要为局部区域复发,且以纵隔复发最常见;肿瘤位置、清扫淋巴结数目、pT分期为影响术后总复发和局部区域复发的独立危险因素;胸上段鳞癌、清扫淋巴结少和pT分期晚者术后复发率高;术前纵隔有小淋巴结者,术后复发率增加。
[Abstract]:The first part of the prognosis of esophageal carcinoma after pN0 Objective: To investigate the prognostic factors and the value of postoperative adjuvant therapy for the postoperative esophagus cancer in pN0. Methods: 1250 cases of thoracic esophageal cancer were collected from January 2008 to December 2012, the postoperative pathological pN0 period, and the postoperative survival time of the thoracic esophagus cancer patients, including 828 males and 422 females. Case: middle age 61 years old,.311 was 31 years old between ~86 years and CT had small diameter 1cm mediastinal lymph nodes; 1214 cases with two field operations, 36 cases with Sanye operation, 167 cases in the upper thoracic segment, 863 in the chest, 220 in the lower thoracic segment, and 5cm in the middle of the esophagus (0.2~14cm); the degree of adhesion in the operation: 120 cases without adhesions and mild adhesion. There were 563 cases, 415 cases of severe adhesion and 152 cases of unknown adhesion, 157 cases in the neck, 62 cases in the pleural top, 907 in the aortic arch, 124 in the aortic arch, 9 in the median of the lymph nodes in the operation (range 0~35), and the postoperative pathological type: moderately high differentiated squamous carcinoma, 121 cases of low differentiated squamous cell carcinoma and 87 cases of non squamous cell carcinoma; postoperative pathological T Staging: 185 cases of pT1, 276 cases in pT2, 755 cases in pT3 stage, 34 cases of.13 routine chemotherapy in pT4 period, 588 cases of simple operation, 622 cases receiving postoperative adjuvant therapy, including 49 cases of adjuvant radiotherapy, 547 cases of chemotherapy and 66 cases of radiotherapy and chemotherapy. Results: the follow-up date was December 1, 2016; the whole group was lost in December 1, 2016. In 17 cases, 17 cases were followed up with 450 cases of tumor progression, of which local regional recurrence accounted for 23% (287/1250), distant metastasis accounted for 8.2% (102/1250), local regional recurrence and distant metastasis accounted for 4.9% (61/1250). The total 1,3,5 year survival rate (OS) in the whole group was 92.7%, 72.6%, 62.1%, respectively, and single factor analysis, sex, age, tumor location, longitudinal Small lymph nodes, surgical methods, intraoperative adhesion, number of lymph nodes, postoperative pathological type, stump positive or not, vascular tumor thrombus, pT staging, postoperative adjuvant therapy were related to OS (P0.05) after the operation of pN0 esophageal carcinoma; multiple factor analysis, sex, age, tumor location, small mediastinal lymph nodes, intraoperative adhesion, lymph node number, and the number of lymph nodes cleaned, and the number of lymph nodes cleaned Post pathological type, pT staging and postoperative adjuvant therapy were independent factors affecting OS after pN0 esophageal carcinoma operation. The 1,3,5 year free survival rate (PFS) in the whole group was 83.8%, 63.9% and 56.9%, respectively. The single factor analysis showed that sex, age, small mediastinal lymph nodes, tumor location, operation mode, degree of adhesion, number of lymph nodes, postoperative pathology Type, stump positive or not, vascular tumor thrombus, pT staging and postoperative adjuvant therapy with PFS (P0.05); multivariate analysis showed that age, tumor location, small mediastinal lymph nodes, intraoperative adhesion, number of lymph nodes, postoperative pathological type, pT staging, postoperative adjuvant therapy were independent risk factors for PFS after pN0 esophagus carcinoma. Simple hand The 1,3,5 year OS of the operator was 89.5%, 69.7%, 59.1% respectively. The OS of postoperative radiotherapy was 83.7%, 59.2%, 39.6% respectively. The postoperative chemotherapy recipients were 94.3%, 76.6%, 68.4% respectively, 1,3,5 year OS, respectively, and postoperative radiotherapy and postoperative chemotherapy 1,3,5 PFS 80.9%, 62.2%, 55.2%, 71.4%, 44.9%, etc. S and PFS (P0.05), and postoperative radiotherapy OS and PFS were significantly lower than that of the simple operation (P0.05), but the postoperative radiotherapy group was later than the simple operation group, and the proportion of the patients with severe adhesion was higher (P0.05). Conclusion: after the operation of stage pN0 stage thoracic esophagus cancer, women, age light, middle and lower thoracic carcinoma, no small lymph nodes in the CT mediastinum before operation, the number of lymph nodes clear, and intraoperative mucus. PT staging early, medium and high differentiated squamous cell carcinoma with better prognosis, and the prognosis was better in the patients with adjuvant chemotherapy, while male, older, upper thoracic carcinoma, small lymph nodes in CT mediastinum, less lymph node number, heavy adhesion in the operation, late pT stage, low differentiated squamous cell carcinoma or non squamous cell carcinoma, and poor prognosis; the effect of postoperative radiotherapy is still to be proved. Second part of the recurrence rule after radical resection of thoracic esophageal squamous cell carcinoma in phase pT1-3N0M0: retrospective analysis of the recurrence rules after two field radical resection of thoracic esophageal squamous cell carcinoma. Methods: to collect radical resection of esophageal carcinoma (R0) from January 2008 to December 2012, pT1-3N0M0 stage of postoperative pathology, and 488 thoracic segment food for 3 months after operation. Data of patients with squamous cell carcinoma, including 303 males and 185 females; age 34~86 years, middle age 62 years old. Tumors located in the upper thoracic segment, 61 in the upper thoracic segment, 344 in the thoracic segment, 83 in the lower thoracic segment, 102 in pT1 stage in pT stage, 126 in pT3 stage, 260 in pT3 phase. Results: the follow-up deadline was the.PT1-3N0M0 phase of December 1, 2016. The total recurrence rate after radical resection of thoracic esophageal squamous cell carcinoma was 36.9% (180/488), the local regional recurrence rate was 21.5% (105/488), the distant metastasis rate was 6.8% (33/488), the local regional recurrence combined with the distant metastasis rate was 8.6% (42/488). The chi square test showed that the tumor location, the number of lymph nodes, the CT mediastinal small lymph nodes and the pT staging and pT1-3N0M0 before the operation. The total recurrence after radical resection of thoracic esophageal squamous cell carcinoma (P0.05); Logistic multivariate analysis showed that the tumor location, the number of lymph nodes, the CT mediastinal small lymph nodes and the pT staging were the independent risk factors for the postoperative total recurrence of the thoracic esophagus, the total local recurrence rate was 30.1% (147/488) after radical resection of the thoracic esophagus squamous carcinoma. 21.1% (31/147), 80.3% (118/147), 7.5% (11/147) recurrences of the mediastinum and abdominal cavity respectively. The chi square test showed that the tumor location, the small lymph node of the CT mediastinum, pT staging with the local regional recurrence after the radical resection of the thoracic esophageal squamous cell carcinoma (P0.05); Logistic multiple factor analysis showed the tumor location, the location of the tumor, clear The number of lymph nodes, pT staging is an independent risk factor affecting local regional recurrence after operation. Conclusion: the recurrence rate of thoracic esophageal squamous cell carcinoma in pT1-3N0M0 stage is higher, mainly local regional recurrence, and the most common mediastinal recurrence; tumor location, the number of lymph nodes clear, pT staging as a result of the total recurrence of postoperative and local regional recurrence alone. The recurrence rate was higher in patients with upper thoracic squamous cell carcinoma, less lymph node clearance and pT staging.
【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】：R735.1

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