食管鳞癌术后淋巴结阳性患者预后因素分析及辅助化疗的价值

发布时间：2018-06-27 20:38

本文选题：食管鳞癌 + 食管癌手术　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:我国是食管癌高发国家,手术是食管癌治疗的主要方式,但单纯手术患者5年生存率仅在30%左右,术后放疗、化疗等辅助治疗已成为改善患者预后的主要手段。NCCN(The National Comprehensive Cancer Network)制定的食管癌治疗指南中指出食管癌术后淋巴结阳性的腺癌患者需行辅助放化疗,而对食管鳞癌患者建议行术后放化疗或观察。众所周知,我国食管原发性腺癌很少,90%以上类型为食管鳞癌,而且NCCN指南的研究对象大多为国外食管腺癌患者,所以其不能完全指导我国食管癌的治疗。并且辅助性放化疗对食管癌根治术后患者的治疗效果,诸多学者的研究结果并不一致,仍存在众多争议。本研究主要对食管鳞癌术后淋巴结阳性患者行辅助化疗的价值以及预后影响因素进行分析,以对如何预防食管癌术后复发及提高术后生存率进行进一步的探究。方法:本研究回顾性分析河北医科大学第四医院2008年1月至2012年2月284例食管鳞癌根治术后淋巴结阳性患者的资料。所有患者术前未行任何治疗且无远处转移,术后病理均为原发性鳞状细胞癌,且淋巴结阳性。本研究的预后相关因素包括性别、年龄、肿瘤位置、肿瘤长径、淋巴结阳性数目(N分期)、肿瘤浸润深度、肿瘤分化程度、淋巴结清扫数目、术后辅助化疗、吸烟史、饮酒史等。以上资料使用SPSS21.0统计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。结果:随访截止至2017年3月,全组284例食管鳞癌术后淋巴结阳性患者3年、5年无病生存率(DFS)分别为28.9%,21%,中位值为15个月(范围1~110个月)。单因素分析显示:肿瘤长径、淋巴结阳性数目(N分期)、肿瘤浸润深度、肿瘤分化程度、术后辅助化疗与DFS相关(P0.05);将肿瘤长径、淋巴结阳性数目(N分期)、肿瘤浸润深度、肿瘤分化程度、术后辅助化疗纳入Cox回归多因素分析显示:N分期(P=0.0000.05)、肿瘤浸润深度(P=0.0070.05)、术后辅助化疗(P=0.0070.05)是影响食管鳞癌术后淋巴结阳性患者DFS的独立预后因素。全组284例食管鳞癌术后淋巴结阳性患者3年、5年总生存率(OS)分别为35.2%,23.9%,中位值为23个月(范围1~110个月);单因素分析显示:肿瘤长径、淋巴结阳性数目(N分期)、肿瘤浸润深度、肿瘤分化程度、术后辅助化疗与OS相关(P0.05);将肿瘤长径、淋巴结阳性数目(N分期)、肿瘤浸润深度、肿瘤分化程度、术后辅助化疗纳入Cox回归多因素分析显示:N分期(P=0.0000.05)、肿瘤浸润深度(P=0.0170.05)、术后辅助化疗(P=0.0010.05)是影响食管鳞癌术后淋巴结阳性患者OS的独立预后因素。其中119例术后辅助化疗患者中,化疗方案的差异与食管鳞癌术后淋巴结阳性患者DFS(P=0.490.05)、OS(P=0.6560.05)无明显相关。结论:1食管鳞癌术后淋巴结阳性患者手术效果欠佳,预后较差,术后N分期是影响食管鳞癌术后淋巴结阳性患者DFS、OS的独立预后因素。并且随着淋巴结阳性个数的增加,生存率逐渐下降。2肿瘤浸润深度是影响食管鳞癌术后淋巴结阳性患者DFS、OS的独立预后因素。并且随着肿瘤浸润深度的增加,患者的预后越差。3术后辅助化疗是影响食管鳞癌术后淋巴结阳性患者DFS、OS的独立预后因素,可以提高患者的DFS及OS,所以建议食管鳞癌术后淋巴结阳性患者行辅助化疗。4不同的辅助化疗方案对食管鳞癌术后淋巴结阳性患者生存差异无统计学意义,仍需大样本量进行深入的探究。
[Abstract]:Objective: China is a country with high incidence of esophageal cancer. Surgery is the main treatment for esophageal cancer, but the 5 year survival rate of patients with simple surgery is only about 30%. Adjuvant therapy, such as postoperative radiotherapy and chemotherapy, has become the main means to improve the prognosis of patients with.NCCN (The National Comprehensive Cancer Network) in the esophagus cancer treatment guide. It is well known that there are few primary adenocarcinoma in our esophagus and more than 90% of the types of esophageal squamous cell carcinoma in our country, and most of the subjects of the NCCN guide are foreign food tube adenocarcinoma patients, so it can not guide our food completely. There are many controversies in the treatment of carcinoma of tube and adjuvant chemotherapy for patients with esophageal cancer after radical resection of esophagus cancer. There are still many disputes. This study is mainly about the value of adjuvant chemotherapy and prognostic factors in the lymph node positive patients after esophageal squamous cell carcinoma, in order to prevent the esophagus cancer after operation. A retrospective analysis of 284 cases of lymph node positive patients after radical resection of esophageal squamous cell carcinoma from January 2008 to February 2012 in fourth hospital of Hebei Medical University was analyzed retrospectively. All patients had no treatment before operation and no distant metastasis, and the postoperative pathology was primary squamous cell carcinoma. The prognostic factors of this study included gender, age, tumor location, tumor length, lymph node positive number (N staging), tumor infiltration depth, tumor differentiation, lymph node dissection, postoperative adjuvant chemotherapy, smoking history, and drinking history. The above data were statistically analyzed using the SPSS21.0 software: application of Kapl An-Meier survival curve and Log-rank test were used for single factor survival analysis and multiple factor survival analysis by Cox regression. Results: 284 cases of squamous cell carcinoma of the esophagus were followed up to March 2017. The 5 year disease free survival rate (DFS) was 28.9%, 21%, and the median value was 15 months (1~110 months). The long diameter of tumor, the positive number of lymph nodes (N staging), the depth of tumor invasion, the degree of tumor differentiation, the correlation of postoperative adjuvant chemotherapy and DFS (P0.05), the length of the tumor, the positive number of lymph nodes (N staging), the depth of the tumor, the degree of differentiation of the tumor, and the postoperative adjuvant chemotherapy in the Cox regression analysis showed that N staging (P=0.0000.05), and tumor soaked. P=0.0070.05, postoperative adjuvant chemotherapy (P=0.0070.05) was an independent prognostic factor for DFS in patients with positive lymph nodes after esophageal squamous cell carcinoma. 284 cases of lymph node positive after esophageal squamous cell carcinoma were 3 years after operation, and the total 5 year survival rate (OS) was 35.2% and 23.9% respectively. The median value was 23 months (1~110 months), and the single factor analysis showed the tumor length, Lymph node positive number (N staging), tumor invasion depth, tumor differentiation degree, postoperative adjuvant chemotherapy and OS correlation (P0.05); tumor length, lymph node positive number (N staging), tumor invasion depth, tumor differentiation degree, postoperative adjuvant chemotherapy into Cox regression multivariate analysis showed: N staging (P=0.0000.05), tumor infiltration depth (P=0.0170.05), Postoperative adjuvant chemotherapy (P=0.0010.05) was an independent prognostic factor affecting OS in patients with positive lymph node metastasis of esophageal squamous cell carcinoma. Among 119 patients with postoperative adjuvant chemotherapy, there was no significant correlation between chemotherapy regimens and DFS (P=0.490.05) and OS (P=0.6560.05) of lymph node positive patients after esophageal squamous cell carcinoma. Conclusion: 1 lymph node positive after operation of squamous cell carcinoma of the esophagus The results were poor and the prognosis was poor. N staging was an independent prognostic factor of DFS and OS in patients with positive lymph nodes after operation. And with the increase of positive lymph node number, the survival rate decreased gradually and the depth of.2 tumor infiltration was the independent prognostic factor of DFS and OS in lymph node positive patients after esophageal squamous cell carcinoma. The worse the depth of tumor infiltration, the worse the prognosis of patients with.3 postoperative adjuvant chemotherapy is an independent prognostic factor of DFS, OS and DFS and OS in patients with positive lymph nodes after operation of esophageal squamous cell carcinoma. Therefore, it is suggested that the postoperative lymph node positive patients with esophageal squamous cell carcinoma undergo adjuvant chemotherapy with different adjuvant chemotherapy regimens for postoperative lymph nodes of esophageal squamous cell carcinoma The survival of positive patients was not statistically significant, and large sample sizes still need to be explored in depth.
【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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