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目的我国食管腺癌发病率低,国内有关食管腺癌术后不同治疗模式疗效的报道并不多见。本研究旨在探讨食管腺癌根治术后不同治疗模式的疗效比较以及影响其预后的主要因素,为综合治疗方案的选择提供参考。方法选择2004-01-01-2013-12-31于河北医科大学第四医院行根治性手术切除的201例食管腺癌患者,其中单纯手术120例,手术+化疗63例,手术+放疗+化疗18例。比较单纯手术组与术后综合治疗组疗效,筛选术后综合治疗获益人群。将性别、年龄、病变部位、病理类型、病变长度、T分期、N分期、pTNM分期、淋巴结转移、脉管瘤栓、化疗与否和放疗与否12项临床病理因素纳入单因素分析和Cox回归多因素分析,寻找食管腺癌根治术后长期生存的主要影响因素。结果全组患者1、3和5年生存率分别为82.0%、49.2%和31.2%。对于淋巴结阳性组患者,术后综合治疗的5年生存率为27.5%,显著高于单纯手术组的6.8%,χ2=6.059;P=0.014;而对于淋巴结转移度>10%和Ⅲ+Ⅳ期患者,术后综合治疗的5年生存率分别为32.1%和27.7%,明显高于单纯手术组的7.3%和6.7%,χ2值分别为6.552和4.861,P值分别为0.010和0.027。单因素分析显示,病理类型、T分期、N分期、pTNM分期、淋巴结转移和脉管瘤栓是生存的主要影响因素。Cox回归多因素分析显示,脉管瘤栓、N分期及术后化疗与否是食管腺癌患者预后的独立影响因素。结论食管腺癌术后淋巴结阳性者,尤其是淋巴结转移度>10%及Ⅲ+Ⅳ期患者,建议行术后综合治疗。脉管瘤栓、N分期及术后化疗与否是影响食管腺癌患者生存的独立影响因素。
Objectives The incidence of esophageal adenocarcinoma in China is low, and the reports of different curative effects of esophageal adenocarcinoma after surgery in China are rare. This study aimed to explore the efficacy of different treatment modalities for esophageal adenocarcinoma after radical resection and the main factors influencing its prognosis, so as to provide a reference for the selection of comprehensive treatment options. Methods A total of 201 patients with esophageal adenocarcinoma who underwent radical resection at the Fourth Hospital of Hebei Medical University from January 2004 to January 2013 were enrolled. Among them, 120 were simple surgery, 63 were surgery plus chemotherapy, 18 cases. Comparison of simple surgery group and postoperative comprehensive treatment group curative effect, screening comprehensive treatment benefit the crowd. The 12 clinical and pathological factors such as sex, age, pathological type, pathological length, T stage, N stage, pTNM stage, lymph node metastasis, tumor thrombus, chemotherapy or not and radiotherapy were included in univariate analysis and Cox regression Multivariate analysis, looking for long-term survival of patients with esophageal adenocarcinoma after the main factors. Results The 1-, 3-, and 5-year survival rates of all patients were 82.0%, 49.2% and 31.2%, respectively. For patients with lymph node-positive disease, the 5-year overall survival rate was 27.5%, significantly higher than 6.8% in the surgery alone group (χ2 = 6.059; P = 0.014), while for lymph node metastasis> 10% and stage Ⅲ + Ⅳ The 5-year survival rates of patients and postoperative comprehensive treatment were 32.1% and 27.7%, respectively, which were significantly higher than 7.3% and 6.7% of those in the operation alone group. The χ2 values were 6.552 and 4.861, P values were 0.010 and 0.027, respectively. Univariate analysis showed that pathological type, T stage, N stage, pTNM stage, lymph node metastasis and tumor thrombus were the main factors affecting survival. Cox regression multivariate analysis showed that the tumor thrombus, N stage and postoperative chemotherapy or not is an independent prognostic factor in patients with esophageal adenocarcinoma. Conclusion Postoperative lymph node positive esophageal adenocarcinoma, especially in patients with lymph node metastasis of> 10% and stage Ⅲ + Ⅳ, recommended postoperative comprehensive treatment. Vascular tumor thrombus, N stage and postoperative chemotherapy or not is an independent factor affecting the survival of patients with esophageal adenocarcinoma.