食管鳞状细胞癌术前放疗后的影响预后因素分析

目的 分析影响食管鳞状细胞癌术前放疗后的预后因素。方法 回顾分析 311例食管鳞状细胞癌术前放疗患者资料,要求有详细临床、病理、放疗和手术记录。采用Kaplan-Meier法计算生存率,Logrank法检验和单因素分析,Cox模型多因素预后分析。结果 随访率为96.5%,随访满3、5年者分别为123、86例。放疗后原发部位无肿瘤(106例)与有肿瘤(205例)的 5年生存率分别为43.2%、23.2%(χ²=11.53,P=0.001。129例原发部位有肿瘤但无淋巴结转移的T₁+T₂、T₃、T₄期 5年生存率分别为42%、30%、16%(χ²=20.20,P=0.000)。211例无淋巴结转移与 95例淋巴结转移 1~3、≥4个的生存率分别为38.3%(5年)与13%(5年)、14%(3年,5年为0)(χ²=42.13,P=0.000)。多因素分析先显示术前放疗后局部有无肿瘤残存、肿瘤浸润深度、淋巴结状态、淋巴结转移个数以及性别是影响预后的因素(χ²=32.20、36.33、18.24、4.60、6.21,P=0.000、0.000、0.000、0.032、0.013)。结论 食管癌术前放疗后病理T、N分期和淋巴结转移个数能预测其预后,是其独立预后因素。

Prognostic factor analysis of preoperative radiotherapy for esophageal squamous cell carcinoma

Objective To evaluate the prognostic factors affecting preoperative radiotherapy for esophageal squamous cell carcinoma (ESCC). Methods Three hundred and eleven patients with ESCC undergone preoperative radiotherapy were retrospectively analyzed. Detailed clinical and histological materials and radiotherapy and surgery records were examined. Univariate and multivariate analyses were used to study the factors affecting prognosis. Results The follow-up rate was 96.5%, 123 and 86 patients,respectively were followed up more than 3 and 5years. The 5-year survival rates of patients without (106 patients) and with (205 patients) tumorremnants in primary locations after radiotherapy were 43.2% and 23.2%, respectively (χ²=11.53,P=0.001). The 5-year survival rates of 129 patients with primary tumor remnants but without lymph node metastasis in the T₁+T₂ phase, the T₃ phase and the T₄ phase were 42%, 30% and 16%, respectively (χ²=20.20,P=0.000). The 5-year survival rates of patients without lymph node metastasis (211 patients) and those whose lymph node metastases numbered less than 4(95 patients) was 38.3% and 13%, respectively;the 3-year survival rate of patients whose lymph node metastases numbered greater than 4 was 14%, and the 5-year survival rate was 0(χ²=42.13,P=0.000). In multivariate analysis, the local region with or without residual cancer, the depth of tumor infiltration, the status of the lymph node, the number of lymph node metastases, and gender were independent prognostic factors (χ²=32.20,36.33,18.24,4.60,6.21, P=0.000, 0.000, 0.000, 0.032, 0.013, respectively). Conclusions Histological T and N staging following preoperative radiotherapy for ESCC andnumbers oflymph node metastases were critical factors affecting prognosis and could be used for better prediction.