Lerut T, De Leyn P, Coosemans W, Van Raemdonck D, Scheys I, LeSaffre E
Department of Surgery, University Hospital, Catholic University of Leuven, Belgium.
Ann Surg. 1992 Nov;216(5):583-90. doi: 10.1097/00000658-199211000-00010.
From 1975 through 1988, 257 patients with carcinoma of the thoracic esophagus have been treated in our department. Operability was 90% (232/257); overall resectability, 77% (198/257), and for the operated group, 85% (198/232). Hospital mortality rate was 9.6% but decreased to 3% over the period 1986 to 1988. There were 65% squamous cell epitheliomas and 35% adenocarcinomas. Tumor, nodes, and metastases (pTNM) staging was as follows: stage I, 11.6%; stage II, 23.2%; stage III, 37.9%; stage IV, 27.3%. Overall survival rate was 62.5% at 1 year, 42.4% at 2 years, and 30% at 5 years. According to the pTNM staging, 5-year survival was 90% for stage I, 56% for stage II, 15.3% for stage III, and 0 for stage IV. There were no statistically significant differences according to tumor localization, pathologic type, sex, or age. Introducing extensive resection and extended lymphadenectomy seems to improve significantly survival in patients in whom an operation with curative intention was performed, the 1 year survival rate being 90.8% versus 72%; 2-year survival, 81% versus 46%; and 5-year survival, 48.5% versus 41% for radical and nonradical resections, respectively. Based on multivariate Cox regression analysis, only TNM stage and presence or absence of lymph nodes are important factors in predicting survival: stage 1 tumors have lower risk, and involvement of lymph nodes creates higher risk. Using this analysis, there was only for the patients with involved lymph nodes (N1) a significantly better prognosis when a radical lymph node dissection was performed (p = 0.0055). Barrett adenocarcinomas have no worse prognosis than other esophageal carcinomas, with a 5-year survival rate of 91.5% if lymph nodes are negative, and a 54% overall 5-year survival rate. Functional results after restoration of continuity with gastric tubulation were judged excellent to very good in 86.5% at 1 year, but infra-aortic anastomoses have a much higher incidence of peptic esophagitis: 53% versus 8% for cervical anastomoses. From this study it can be concluded that in experienced hands surgery today offers the best chances for optimal staging, potential cure, and prolonged high-quality palliation.
1975年至1988年期间，我科共治疗了257例胸段食管癌患者。可手术率为90%（232/257）；总体切除率为77%（198/257），手术组的切除率为85%（198/232）。医院死亡率为9.6%，但在1986年至1988年期间降至3%。其中鳞状细胞上皮癌占65%，腺癌占35%。肿瘤、淋巴结及转移灶（pTNM）分期如下：Ⅰ期，11.6%；Ⅱ期，23.2%；Ⅲ期，37.9%；Ⅳ期，27.3%。1年总生存率为62.5%，2年为42.4%，5年为30%。根据pTNM分期，Ⅰ期5年生存率为90%，Ⅱ期为56%，Ⅲ期为15.3%，Ⅳ期为0。根据肿瘤部位、病理类型、性别或年龄，无统计学显著差异。采用广泛切除和扩大淋巴结清扫术似乎能显著提高行根治性手术患者的生存率，根治性切除和非根治性切除的1年生存率分别为90.8%和72%；2年生存率分别为81%和46%；5年生存率分别为48.5%和41%。基于多因素Cox回归分析，只有TNM分期和有无淋巴结转移是预测生存的重要因素：Ⅰ期肿瘤风险较低，淋巴结受累则风险较高。通过该分析，仅对有淋巴结转移（N1）的患者，行根治性淋巴结清扫术时预后明显更好（p = 0.0055）。Barrett腺癌的预后并不比其他食管癌差，若淋巴结阴性，5年生存率为91.5%，总体5年生存率为54%。采用胃管重建消化道连续性后，1年时功能结果评为优至良的比例为86.5%，但主动脉弓下吻合口的消化性食管炎发生率要高得多：分别为53%和8%（颈段吻合口）。从本研究可以得出结论，在经验丰富的医生手中，如今手术为实现最佳分期、潜在治愈及延长高质量姑息治疗提供了最佳机会。
