术后化疗对术后淋巴结阳性胸段食管鳞癌患者预后的影响

沈文斌; 高红梅; 祝淑钗; 李幼梅; 李腾; 李曙光; 许金蕊; 刘志坤; 李娟; 苏景伟

doi:10.3971/j.issn.1000-8578.2018.18.0118

术后化疗对术后淋巴结阳性胸段食管鳞癌患者预后的影响

Effect of Postoperative Chemotherapy on Prognosis of Postoperative Lymph Node-positive Thoracic Esophageal Squamous Cell Carcinoma Patients

摘要

摘要:
目的分析术后化疗对术后淋巴结阳性胸段食管鳞癌患者预后的影响。
方法回顾性分析419例胸段食管癌患者预后的影响因素。
结果单纯手术患者1、3、5年OS显著低于术后化疗组（χ²=12.802, P=0.000）；而两组患者1、3、5年DFS差异未见统计学意义（χ²=1.159, P=0.282）。多因素分析结果显示，性别、年龄、病变部位、TNM分期、术后化疗和化疗周期数为OS的独立性预后影响因素（P < 0.05）；而性别和N分期为DFS的独立性预后影响因素（P < 0.05）。分层分析结果显示，相对于单纯手术，术后化疗可以提高男性、年龄≤60岁、胸中下段病变、病变长度≤5.0 cm和ⅢB期患者的OS（P < 0.05），而且可以提高男性和年龄≤60岁患者的DFS（P < 0.05）。
结论术后淋巴结阳性胸段食管鳞癌患者预后较差，术后化疗可以提高部分患者的预后。

Abstract:
Objective To analyze the effect of postoperative chemotherapy (POCT) on the prognosis of postoperative lymph node-positive thoracic esophageal squamous cell carcinoma (TESCC) patients.
Methods We retrospectively analyzed the prognostic factors for 419 lymph node-positive TESCC patients.
Results Compared with POCT group, the 1-, 3- and 5-year OS was significantly lower in patients with surgery alone(χ²= 12.802, P=0.000), while there was no significant difference in 1-, 3- or 5-year DFS (χ²=1.159, P=0.282). Multivariate analysis results showed that gender, age, location of lesion, TNM stage, POCT and chemotherapy cycles were the prognostic factors of OS (P < 0.05), and gender and N stage were the independent prognostic factors of DFS (P < 0.05). Hierarchical analysis results showed that POCT increased OS of male patients ≤60 years of age, lower thoracic lesions, lesions ≤5.0 cm and stage ⅢB, compared with surgery alone (P < 0.05), and also increased DFS of men ≤60 years of age (P < 0.05).
Conclusion The prognosis of postoperative lymph node-positive TESCC patients is poor, POCT could improve the prognosis of some patients.

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