食管癌非手术分期与术后分期比较及生存预后因素分析

发布时间：2018-07-06 08:29

本文选题：食管癌 + 根治性手术　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:探讨非手术食管癌的临床分期标准(草案)【1】与根据第8版AJCC/UICC食管癌TNM分期标准进行的术后病理分期的一致性及两种分期标准对食管癌患者预后判断的临床价值。并探讨食管癌根治术后相关预后因素。方法:回顾分析2012年6月至2016年10月在我院行食管癌根治性手术患者的临床资料,并通过电话进行随访。根据患者术前CT及钡餐等,采用非手术治疗食管癌的临床分期标准(草案)行术前分期,根据术后病理结果,运用第8版AJCC/UICC食管癌TNM分期标准行术后分期。采用Kappa法检验两种分期标准的各期患者分布一致性,并采用Kaplan-Meier法对两种分期各T、N及TNM分期进行生存分析。对可能影响食管癌根治术后患者的预后因素进行单因素及多因素分析。结果:(1)本研究共入组148例患者。中位生存期为25个月(1-54个月)。1、2、3年生存率为82.0%、51.2%、20.5%。(2)术前分期与术后分期符合情况:104例患者T分期相符,符合率70.3%,Kappa值0.528,一致性中等;100例患者N分期相符,符合率67.6%,Kappa值0.470,一致性中等;90例患者TNM分期相符,符合率60.8%,Kappa值0.402,一致性中等。(3)两种分期标准的T、N及TNM分期的生存曲线均能较好分开,对预后判断有预示作用。(4)多因素分析显示年龄、UICC T分期、肿瘤部位、病理类型、分化程度、淋巴结转移、饮酒史为食管癌根治术后患者独立危险因素。结论:非手术食管癌临床分期(草案)与术后分期一致性中等,并且能够将各分期生存曲线分开,是值得进一步研究的食管癌临床分期方法。年龄、肿瘤部位、UICC T分期、病理类型、淋巴结转移、饮酒史是食管癌根治性手术的独立预后因素,对于预后有较好判断作用。
[Abstract]:Objective: to investigate the consistency between the clinical staging criteria (draft) of non-operative esophageal carcinoma (draft) and the postoperative pathological staging according to the 8th edition of AJCC / UICC TNM staging standard for esophageal carcinoma and the clinical value of the two staging criteria in judging the prognosis of esophageal cancer patients. To explore the prognostic factors after radical resection of esophageal carcinoma. Methods: the clinical data of patients undergoing radical esophageal cancer surgery from June 2012 to October 2016 were retrospectively analyzed and followed up by telephone. According to the preoperative CT and barium meal, the clinical staging standard (draft) for non-operative treatment of esophageal carcinoma was used. According to the postoperative pathological results, the 8th edition of AJCC / UICC TNM staging standard was used for postoperative staging of esophageal carcinoma. Kappa method was used to test the consistency of distribution between the two stages, and Kaplan-Meier method was used to analyze the survival of the two stages. Univariate and multivariate analysis was performed on the prognostic factors of patients with esophageal cancer after radical resection. Results: (1) 148 patients were enrolled in this study. The median survival time was 25 months (1-54 months). The 3-year survival rate was 82.0 and 51.2 and 20.5. (2) the preoperative and postoperative stages were consistent with T staging in 10 ~ 104 patients. The coincidence rate of Kappa was 0.470, and 90 patients with moderate consistency were consistent with TNM staging. The coincidence rate was 60.8 and 0.402, respectively. (3) the survival curves of TN and TNM stages of the two staging criteria could be well separated. (4) multivariate analysis showed that age UICC T stage, tumor location, pathological type, differentiation degree, lymph node metastasis and drinking history were independent risk factors for patients with esophageal cancer after radical operation. Conclusion: the clinical stage (draft) of non-operative esophageal carcinoma is of moderate consistency with postoperative stage and can separate the survival curve of each stage. It is a clinical staging method worthy of further study. Age, tumor location, UICC T stage, pathological type, lymph node metastasis and drinking history were independent prognostic factors for radical operation of esophageal carcinoma.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.1

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