[胸段食管癌手术切除术后患者的生存分析]

[Analysis of the survival in patients after surgical resection of thoracic esophageal cancer].

作者信息

Zhang He-Lin, Liu Rui-Lin, Shi Yan-Tan, Wang Zhi-Chao, Wang Bao-Hua, Li Yong-Jun, Zhou Lian-Ya, Ping Yu-Min

机构信息

Department of Thoracic Surgery, Second Hospital of Hebei Medical University, Shijiazhuan 050000, China.

出版信息

Zhonghua Zhong Liu Za Zhi. 2009 Jul;31(7):541-5.

PMID:19950705

Abstract

OBJECTIVE

To investigate the prognostic factors and influence of the number of lymph node metastases on survival and UICC-TNM classification in patients with thoracic esophageal cancer after curative resection.

METHODS

From 1985 to 1990, 1224 patients were surgically treated for thoracic esophageal cancer. The patients who died within 30 days after operation were not included in this study. Fifteen factors possibly influencing survival of these patients were selected and analyzed. A multivariate analysis of these individual variables was performed by Cox proportional hazard model. According to the number of lymph node metastases (0, 1 and > or = 2), a new modification of the TNM classification was suggested: stage IIa (T2N0M0 and T3N0M0), stage IIb [T1N1M0 and T2N1(1)M0], stage IIIa [T2N1 (2)M0 and T3N1 (1) M0] and stage IIIb [T3N1 (2) M0 and T4N any M0].

RESULTS

According to multivariate analysis, lymph node metastases, depth of invasion, location of tumor, histological classification and length of the tumor were of prognostic significance (P < 0.01). There was obvious correlation between the rate of lymph node metastasis and the depth of invasion, length of tumor and grade of differentiation. The 5-year survival rate of the patients with 0, 1 and > or = 2 positive metastatic lymph nodes was 59.1%, 32.0% and 8. 9%, respectively. The 5-year survival rate of the patients with stage T2N1 M0 and stage T3N1 M0 was significantly higher in those with only one lymph node involved than in those with two or more lymph nodes involved (43.1% vs. 18.0% and 28.0% vs. 9.6%, P < 0.01). The 5-year survival rate of the modified stage IIa, IIb, IIIa and IIIb was 56.5%, 43.9%, 25.6% and 11.1%, respectively, with a statistically significant difference among different stages (P < 0.01).

CONCLUSION

The lymph node metastasis is the most important prognostic factor for thoracic esophageal cancer after resection. The major influencing factors of lymph node metastasis are the depth of invasion, length of tumor and grade of differentiation. Therefore, the lymphadenectomy along with esophagectomy and subsequently combined modality therapy against lymph node metastasis is necessary to improve the 5-year survival rate. Our proposed new classification based on number of lymph node metastases (0, 1, > or = 2 positive nodes) is more applicable because it can well reflect the correlation between lymph node metastasis and the survival, and provides evidence for the modification of the currently used UICC TNM staging system for surgically treated thoracic esophageal cancer.

摘要

目的

探讨胸段食管癌根治性切除术后淋巴结转移数量对生存及国际抗癌联盟（UICC）-TNM分期的预后因素及影响。

方法

1985年至1990年，1224例患者接受胸段食管癌手术治疗。术后30天内死亡的患者未纳入本研究。选择并分析了15个可能影响这些患者生存的因素。采用Cox比例风险模型对这些个体变量进行多因素分析。根据淋巴结转移数量（0、1和≥2），提出了TNM分期的新修订：Ⅱa期（T2N0M0和T3N0M0），Ⅱb期[T1N1M0和T2N1(1)M0]，Ⅲa期[T2N1(2)M0和T3N1(1)M0]和Ⅲb期[T3N1(2)M0和T4N任何M0]。

结果

多因素分析显示，淋巴结转移、浸润深度、肿瘤位置、组织学分类和肿瘤长度具有预后意义（P<0.01）。淋巴结转移率与浸润深度、肿瘤长度和分化程度之间存在明显相关性。有0个、1个和≥2个阳性转移淋巴结患者的5年生存率分别为59.1%、32.0%和8.9%。T2N1M0期和T3N1M0期患者中，仅1个淋巴结受累者的5年生存率显著高于2个或更多淋巴结受累者（43.1%对18.0%，28.0%对9.6%，P<0.01）。修订后的Ⅱa期、Ⅱb期、Ⅲa期和Ⅲb期患者的5年生存率分别为56.5%、43.9%、25.6%和11.1%，不同分期之间差异有统计学意义（P<0.01）。

结论

淋巴结转移是胸段食管癌切除术后最重要的预后因素。淋巴结转移的主要影响因素是浸润深度、肿瘤长度和分化程度。因此，为提高5年生存率，除食管切除外进行淋巴结清扫及随后针对淋巴结转移的综合治疗是必要的。我们基于淋巴结转移数量（0个、1个、≥2个阳性淋巴结）提出的新分类更适用，因为它能很好地反映淋巴结转移与生存之间的相关性，并为目前用于手术治疗胸段食管癌的UICC TNM分期系统的修订提供依据。