pT3N0M0期胸段食管鳞癌根治术后的预后因素

王玉祥; 王丽丽; 杨琼; 李静; 齐战; 何明; 姚继方; 乔学英

doi:10.3971/j.issn.1000-8578.2016.06.010

pT3N0M0期胸段食管鳞癌根治术后的预后因素

Prognosis Factors for Patients with Stage pT3N0M0 Thoracic Esophageal Squamous Cell Carcinoma after Radical Resection

摘要

摘要:
目的探讨pT3N0M0期胸段食管鳞癌两野根治术后的预后及其影响因素。

方法胸段食管鳞癌行胸腹两野食管癌根治术后、分期为pT3N0M0者249例，中位年龄60岁（33~78岁）；胸上段39例、胸中段166例、胸下段44例，病变中位长度5 cm（2~12 cm）；术中无粘连者35例、轻度粘连者90例、重度粘连者124例；术中清扫淋巴结中位数9枚（1~27枚）；98例单纯手术、151例行术后辅助治疗。

结果 249例中1、3、5年总生存率（overall Survival, OS）和无进展生存率（progression-free survival, PFS）分别为90.0%、68.7%、55.2%和82.1%、61.7%、5 3 . 9%。单因素分析结果显示：性别、肿瘤位置、病理分化程度和术前血红蛋白水平与O S 有关（P<0.05）；年龄、肿瘤位置和术中粘连程度与PFS有关（P<0.05）；多因素分析结果显示：肿瘤位置、术前血红蛋白水平、术前CT有纵隔小淋巴结（<1 cm）和清扫淋巴结数目是OS独立影响因素，肿瘤位置是影响PFS独立危险因素。术后辅助治疗对OS和PFS均无明显影响；但术前CT纵隔有小淋巴结（<1 cm）者，术后辅助治疗可以提高OS和PFS（P<0.05）。

结论 pT3N0M0期胸段食管鳞癌胸腹两野根治术后，肿瘤位置影响OS和PFS，胸下段癌预后最好，胸上段癌预后最差；术中清扫淋巴结数多、术前CT纵隔无淋巴结者预后较好，反之预后较差；术前血红蛋白高者生存率低；而术后辅助治疗的价值有待证实。

Abstract:
Objective To evaluate the prognosis and its related factors for the patients with pT3N0M0 thoracic esophageal squamous cell carcinoma (ESCC).

Methods Two hundred and forty-nine patients with thoracic ESCC were treated with radical resection and the pathological stage was UICC stage T3N0M0. The median age was 60 years old (range 33-78years). There were 39 cases in the upper-, 166 cases in the middle-, and 44 cases in the lower-thoracic esophagus; the median length of lesion was 5cm (range 2-12cm); as per surgery records, 35, 90 and 124 cases were with none, mild and severe adhesion of surgery, respectively; the median number of removed lymph nodes was 9 (range 1-27) . There were 98 cases with surgery alone and 151 cases with postoperative adjuvant treatment. The statistical analysis used SPSS13.0 statistical software.

Results The 1-, 3-, 5-year overall survival(OS) and progression-free survival(PFS) were 90.0%, 68.7%, 55.2% and 82.1%, 61.7%, 53.9%, respectively. Univariate analysis showed that gender, tumor site, pathological differentiated degree and hemoglobin level before surgery were associated with OS(P<0.05) ; the age, tumor site and adhesion degree during surgery were associated with PFS(P<0.05) . Multivariate analysis showed tumor site, preoperative hemoglobin levels and small mediastinal lymph node(<1cm) in CT before surgery, the number of removed lymph nodes were the independent prognostic factors for OS; tumor site was the only independent factor for PFS. Postoperative adjuvant therapy had not effect on OS or PFS; for patients with small mediastinal lymph node(<1cm) in CT before surgery, the postoperative adjuvant therapy could improve OS and PFS (P<0.05) .

Conclusion For the patients with stage pT3N0M0 thoracic ESCC treated with radical resection, tumor site is the independent factor for OS and PFS; the prognosis is superior in the upper-, and poor in the lower-ESCC; the prognosis is favorable in the patients who are dissected more lymph nodes at surgery or with out mediastinal lymph node in CT before surgery, and vice verse. The OS is inferior in the patients with high level of hemoglobin before surgery. The value of postoperative adjuvant therapy is needed be proved.

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