食管癌切除术后的生存率：组织学细胞类型的重要性。

Survival after esophageal resection for carcinoma: the importance of the histologic cell type.

作者信息

Alexiou Christos, Khan Omar A, Black Edward, Field Mark L, Onyeaka Patrick, Beggs Lynda, Duffy John P, Beggs David F

机构信息

Department of Cardiothoracic Surgery, Nottingham City Hospital, Nottingham, United Kingdom.

出版信息

Ann Thorac Surg. 2006 Sep;82(3):1073-7. doi: 10.1016/j.athoracsur.2006.03.012.

DOI:10.1016/j.athoracsur.2006.03.012

PMID:16928541

Abstract

BACKGROUND

The significance of tumor cell type on survival after esophageal resection for carcinoma is uncertain. We reviewed our experience in order to compare the outcome in the two main histologic groups.

METHODS

Between January 1987 and April 2000, 621 patients underwent esophagectomy with curative intention for squamous cell carcinoma or adenocarcinoma. The postoperative outcomes of patients with adenocarcinoma and squamous cell carcinoma were compared.

RESULTS

Of the cohort, 424 patients had adenocarcinoma (group A) and 197 had squamous cell carcinoma (group B). The commonest approach in group A was a left thoracotomy (67%), while in group B, it was an Ivor Lewis resection (55%) (p < 0.0001). Operative mortality was 3.5% for group A and 8.1% for group B (p = 0.03). Cardiorespiratory complication rate was similar, but anastomotic leaks occurred more frequently in group B (4.2% vs 8.6%, p = 0.04). Patients in group B tended to have earlier pathologic tumor, node, metastasis (pTNM) stage (p = 0.06). Overall, survival was significantly better for group B (p = 0.003). Group B had a significantly better survival than group A in lymph node (LN) negative status (p = 0.01), and a relatively improved survival in LN positive status (p = 0.35). On multivariate analysis, squamous cell subtype (p = 0.034), pTNM stage (p = 0.005), LN status (p = 0.008), and completeness of resection (p = 0.028) were significant predictors of survival.

CONCLUSIONS

After esophagectomy, patients with squamous cell carcinoma have a poorer perioperative outcome as compared with those with adenocarcinoma. However, in the longer term, squamous cell type appears to confer a significant survival advantage.

摘要

背景

肿瘤细胞类型对食管癌切除术后生存的意义尚不确定。我们回顾了我们的经验，以比较两个主要组织学组的结果。

方法

1987年1月至2000年4月期间，621例患者因鳞状细胞癌或腺癌接受了根治性食管切除术。比较了腺癌和鳞状细胞癌患者的术后结果。

结果

在该队列中，424例患者患有腺癌（A组），197例患有鳞状细胞癌（B组）。A组最常见的手术方式是左胸切开术（67%），而B组是艾弗·刘易斯切除术（55%）（p<0.0001）。A组手术死亡率为3.5%，B组为8.1%（p=0.03）。心肺并发症发生率相似，但B组吻合口漏发生率更高（4.2%对8.6%，p=0.04）。B组患者的病理肿瘤、淋巴结、转移（pTNM）分期往往较早（p=0.06）。总体而言，B组的生存率明显更高（p=0.003）。B组在淋巴结（LN）阴性状态下的生存率明显高于A组（p=0.01），在LN阳性状态下的生存率相对提高（p=0.35）。多因素分析显示，鳞状细胞亚型（p=0.034）、pTNM分期（p=0.005）、LN状态（p=0.008）和切除完整性（p=0.028）是生存的重要预测因素。