Department of Thoracic Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
The First Clinical Medical School, Xuzhou Medical University, Xuzhou, China.
Am Surg. 2024 Jun;90(6):1463-1474. doi: 10.1177/00031348241241727. Epub 2024 Mar 26.
Esophageal cancer is a prevalent malignant tumor of the upper gastrointestinal tract. The aim of this study was to examine the impact of surgical adherence on the prognosis of patients with locally advanced lower esophageal cancer and to analyze the factors that affect surgical adherence.
Patients diagnosed with locally advanced (IIA-IVA) lower esophageal cancer between 2004 and 2015 were screened from the Surveillance, Epidemiology, and End Results (SEER) database. We utilized multifactorial logistic regression to analyze the correlates affecting surgical adherence. Furthermore, we employed Kaplan-Meier curves and Cox regression to determine the impact of surgical adherence on cancer-specific survival (CSS) and overall survival (OS).
Of the 4922 patients screened, 2372 individuals were advised to undergo surgery, out of which 2025 ultimately underwent the procedure while the remaining 347 refused. Lower surgical adherence was associated with older age, unmarried, SEER classification of "distant," and squamous cell carcinoma. Adherence to surgery proved to be an independent factor affecting OS and CSS. The Cox regression analysis showed that patients who refused surgery had lower OS (: 1.657; 95% : 1.429∼1.927; < .001) and CSS (: 1.487; 95% : 1.309∼1.690; < .001) than those who underwent surgery. Kaplan-Meier curves showed that patients who underwent surgical treatment had a better prognosis.
Good surgical adherence can improve the prognosis of patients with locally advanced (IIA-IVA) lower esophageal cancer, while poor surgical adherence is associated with older age, unmarried, SEER classification of "distant," and squamous cell carcinoma.
食管癌是一种常见的上消化道恶性肿瘤。本研究旨在探讨手术依从性对局部晚期下段食管癌患者预后的影响，并分析影响手术依从性的因素。
从监测、流行病学和最终结果（SEER）数据库中筛选出 2004 年至 2015 年间诊断为局部晚期（IIA-IVA）下段食管癌的患者。我们利用多因素逻辑回归分析影响手术依从性的相关因素。此外，我们还采用 Kaplan-Meier 曲线和 Cox 回归分析手术依从性对癌症特异性生存（CSS）和总生存（OS）的影响。
在筛选出的 4922 名患者中，有 2372 名被建议接受手术治疗，其中 2025 名最终接受了手术，而其余 347 名拒绝了手术。较低的手术依从性与年龄较大、未婚、SEER 分类为“远处”和鳞状细胞癌有关。手术依从性是影响 OS 和 CSS 的独立因素。Cox 回归分析显示，拒绝手术的患者 OS 较低（HR：1.657；95%CI：1.429∼1.927；<0.001）和 CSS 较低（HR：1.487；95%CI：1.309∼1.690；<0.001）。Kaplan-Meier 曲线表明，接受手术治疗的患者预后较好。
良好的手术依从性可以改善局部晚期（IIA-IVA）下段食管癌患者的预后，而较差的手术依从性与年龄较大、未婚、SEER 分类为“远处”和鳞状细胞癌有关。
