食管癌术后存活率及生活质量的相关因素分析
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摘要
目的:食管癌术后生存率以及生活质量受多方面因素影响,如年龄、术前心肺功能、手术切口选择、消化道重建方式、临床分期、术后并发症、术后化疗、饮食营养与精神因素等,本文拟通过探讨临床分期、淋巴结转移情况、术后化疗对食管癌术后存活率及生活质量的影响,为食管癌诊治提供临床依据。
方法:2003年至2010年在我院胸外科确诊食管癌并行根治性手术治疗的病例中,有完整资料的共227例,通过电话联系或上门访问,对这227例患者进行跟踪随访,分析影响存活率及生活质量情况的相关因素。采用Kaplan - Meier法计算生存率, Log - Rank检验比较生存差别,生活质量评分采用T检验。
结果:不同病理分期对生存率的影响差异具有统计学意义,本组患者Ⅰ期和Ⅱa期、Ⅱb期、Ⅲ期及Ⅳ期1年生存率分别为91.7%、86.8%、65.4%和40% , 3年生存率分别为71.3%、50.2%、38.1%和40%;5年生存率分别为63.3%、40.2%、38.1%和20%。P < 0.01,有显著差异;淋巴结转移阴性患者比阳性患者总体生存期要长, P < 0.01,有显著差异;术后化疗对生活质量的无明显影响,P > 0.05,差异无统计学意义。早期患者的生活质量明显比晚期患者高,P < 0.01,有显著统计学意义(Ⅰ+Ⅱa期与Ⅲ期比较),食管癌淋巴结转移阴性患者与阳性患者生活质量比较,前者生活质量高,P < 0.05,两组患者生存期有统计学意义;术后有否行化疗对患者生活质量影响无统计学意义,P > 0.05。
结论:在本研究人群中,临床分期对其存活率及生活质量有显著影响;淋巴结转移对其存活率及生活质量有影响;术后化疗对存活率和生活质量无影响。
Objective: The survival rate and quality of life after Esophageal Cancer operation affected by various factors, such as age, preoperative cardiopulmonary function, surgical incision, digestive tract reconstruction, clinical stage, postoperative complications, postoperative chemotherapy, nutrition, mental factors and so on. This paper discusses the clinical stage, lymph node metastases and postoperative chemotherapy on Survival rate and postoperative quality of life after esophageal cancer operation.
Methods: A total of 227 cases with esophageal carcinoma underwent radical esophagectomy with complete data who were admitted to 1st Affiliated Hospital of Shantou University Medical College between 2003 and 2010 were selected in this study.Followed up these 227 cases by telephone connection or home visit, analyze the related factors for survival rates and quality of life after esophageal cancer operation. Analyzed the survival rates by Kaplan - Meier method; Analyzed the survival differences by Log - Rank test comparison; Analyzed the the quality of life score by T test.
Results: The affect of Different clinical stages on the survival rate is statistical significance, P <0.01.In this group, of StageⅠ&Ⅱa,Ⅱb,ⅢandⅣis 91.7%, 86.8%, 65.4% and 40% , 3 year survival rate is 71.3%, 50.2%, 38.1 and 40%;5 year survival rate 63.3%, 40.2%, 38.1% and 20%. P < 0.01, it is significant. Lymph node metastasis on the survival rate, P < 0.01, it is significant.Postoperative chemotherapy on the survival rate, P > 0.05, the difference was not statistically significant. The affect of Different clinical stages on quality of life is statistical significance, P < 0.01 and it is significant differences (comparison between stageⅠ+Ⅱa andⅢ) . Compared the life quality of Patients with positive lymph node metastasis and patients with negative lymph node metastasis, P < 0.05, both groups was statistically significant. Postoperative chemotherapy on the quality of life had no significant impact, P > 0.05.
Conclusions: In this study population, clinical stage on survival rates and quality of life had significant correlation. Lymph node metastasis on survival rates and quality of life had significant correlation.Postoperative chemotherapy on survival rates and quality of life had no significant correlation.
方法:2003年至2010年在我院胸外科确诊食管癌并行根治性手术治疗的病例中,有完整资料的共227例,通过电话联系或上门访问,对这227例患者进行跟踪随访,分析影响存活率及生活质量情况的相关因素。采用Kaplan - Meier法计算生存率, Log - Rank检验比较生存差别,生活质量评分采用T检验。
结果:不同病理分期对生存率的影响差异具有统计学意义,本组患者Ⅰ期和Ⅱa期、Ⅱb期、Ⅲ期及Ⅳ期1年生存率分别为91.7%、86.8%、65.4%和40% , 3年生存率分别为71.3%、50.2%、38.1%和40%;5年生存率分别为63.3%、40.2%、38.1%和20%。P < 0.01,有显著差异;淋巴结转移阴性患者比阳性患者总体生存期要长, P < 0.01,有显著差异;术后化疗对生活质量的无明显影响,P > 0.05,差异无统计学意义。早期患者的生活质量明显比晚期患者高,P < 0.01,有显著统计学意义(Ⅰ+Ⅱa期与Ⅲ期比较),食管癌淋巴结转移阴性患者与阳性患者生活质量比较,前者生活质量高,P < 0.05,两组患者生存期有统计学意义;术后有否行化疗对患者生活质量影响无统计学意义,P > 0.05。
结论:在本研究人群中,临床分期对其存活率及生活质量有显著影响;淋巴结转移对其存活率及生活质量有影响;术后化疗对存活率和生活质量无影响。
Objective: The survival rate and quality of life after Esophageal Cancer operation affected by various factors, such as age, preoperative cardiopulmonary function, surgical incision, digestive tract reconstruction, clinical stage, postoperative complications, postoperative chemotherapy, nutrition, mental factors and so on. This paper discusses the clinical stage, lymph node metastases and postoperative chemotherapy on Survival rate and postoperative quality of life after esophageal cancer operation.
Methods: A total of 227 cases with esophageal carcinoma underwent radical esophagectomy with complete data who were admitted to 1st Affiliated Hospital of Shantou University Medical College between 2003 and 2010 were selected in this study.Followed up these 227 cases by telephone connection or home visit, analyze the related factors for survival rates and quality of life after esophageal cancer operation. Analyzed the survival rates by Kaplan - Meier method; Analyzed the survival differences by Log - Rank test comparison; Analyzed the the quality of life score by T test.
Results: The affect of Different clinical stages on the survival rate is statistical significance, P <0.01.In this group, of StageⅠ&Ⅱa,Ⅱb,ⅢandⅣis 91.7%, 86.8%, 65.4% and 40% , 3 year survival rate is 71.3%, 50.2%, 38.1 and 40%;5 year survival rate 63.3%, 40.2%, 38.1% and 20%. P < 0.01, it is significant. Lymph node metastasis on the survival rate, P < 0.01, it is significant.Postoperative chemotherapy on the survival rate, P > 0.05, the difference was not statistically significant. The affect of Different clinical stages on quality of life is statistical significance, P < 0.01 and it is significant differences (comparison between stageⅠ+Ⅱa andⅢ) . Compared the life quality of Patients with positive lymph node metastasis and patients with negative lymph node metastasis, P < 0.05, both groups was statistically significant. Postoperative chemotherapy on the quality of life had no significant impact, P > 0.05.
Conclusions: In this study population, clinical stage on survival rates and quality of life had significant correlation. Lymph node metastasis on survival rates and quality of life had significant correlation.Postoperative chemotherapy on survival rates and quality of life had no significant correlation.
引文
1.全国肿瘤防治研究办公室,卫生部卫生统计信息中心.中国恶性肿瘤危险因素研究[M].北京:中国协和医科大学出版社,2003. 235.
2.江吕泉,孙江,陈健.食管癌患者术后生存十年以上回顾分析.中国癌症杂志,2001,11(4):322-324.
3.木拉尔.食管癌X线钡餐造影检查.中外医疗,2009,28(34):181.
4.彭兴建,李蓉.105例早期食管癌X线表现及临床分析.现代临床医学,2009,35(1):62-63.
5.吴恩惠,尚克牛.中华影像医学消化系统卷[M].北京:人民卫生出版社,2002.65-66.
6.黄少宇,罗建光,王远波.螺旋CT扫描在食管癌术前分期评估中的价值.中国现代医药杂志,2009,11(7): 122-123.
7.祝淑钗,李任,李娟,邱嵘,韩春,万钧.非手术治疗胸段食管癌临床分期与预后关系的初步探讨.中华放射肿瘤学杂志2004,13:189-192.
8.陈德玉,欧阳卫平.胸部CT扫描对食管癌放疗计划的价值[J].江苏大学学报(医学版),2004,14(2):130-132.
9.王振军,郑琳.中晚期食管癌术前CT分期的临床应用价值.中国煤炭工业医学杂志,2006 9(8):867-867.
10.刘明,李彩英,万欣,彰俊杰,万钧.304例放射治疗为主的食管癌CT分期研究.中华放射肿瘤学杂志,2004, 13(1):18-20.
11.高献书,陈坤,周志国,时高峰,张萍,万钧.放射治疗食管癌CT分期的研究.河北医科大学学报,2003,24(3):153-154.
12. Weavera SR, Blackshawa GR, Lewis WG, et al. Comparison of special interest computed tomography, endosonography and histopathological stage of oesophageal cancer. Clinical[J]. Clin Radiol,2004, 59(6):499- 504
13. Schirmer CC, Osvaldt AB, Gurski RR, et al. Efficacy of computedaxial tomography in the evaluation of the involvement of the respiratory tract in patients with squamous cell carcinoma of esophagus[J]. Dis Esophagus, 1999, 12(3):196-201
14.仝国林.食管拉网在早期食管贲门癌诊治中的应用.中国误诊学杂志,2003,3(6):941-942.
15.曹丽君,熊里守.超声内镜检查在食管癌术前的诊断价值.南华大学学报:医学版,2008,36(2):179-181.
16.王秀茹.食管癌内镜诊断技术研究进展.河北医药,2007,29(7):731-733.
17.陈洁,张召珍.微探头超声内镜在食管癌术前分期中的应用分析.社区医学杂志,2009,23:61-62.
18.张逊.食管癌术前病理分期的诊断方法.肿瘤防治研究,2005,32(3):180-182.
19.李沧海.食管癌贲门癌外科治疗120例报告,实用医学杂志2006,13(24):4372.
20. Kumar S,Kumar A,Pawar DK.Thoracoscopic management of thoracic duct injury:Is there a place for conservatism[J].Postgrad Med,2004,50:57-59.
21. Wemyss-Holden SA,Launois B,Maddern GJ.Management of thoracic duct injuries after oesophagectomy[J].BrSurg,2001,88:1442-1448.
22. Alexiou C,Watson M,Beggs D,et al.Chylothorax following oesophagogastrectomy for malignant disease[J].Eur Cardiothorac Surg,1998,14:460-466.
23. Steyerberg EW, Neville BA, Kopper LB, Lemmens VE, et al. Surgical mortality in patients with esophageal cancer: development and validation of a simple risk score. J Clin Oncol 2006;24 (26):4277-4284.
24. De Hoyos A, Litle VR, and Luketich JD. Minimally invasive esophagectomy. Surg Clin North Am 2005;85 (3): 631-647.
25. Hofstetter WL. Lymph Node Dissection in Esophageal Cancer. Current Therapies in Thoracic and Cardiovascular Surgery, edited by SC Yang and DE Cameron. Mosby, Inc., Philadelphia, Pennsylvania, pp. 360-363, 2004.
26. Swisher SG, Wynn P, Putnam JB, Mosheim MB, et al. Salvage esophagectomy for recurrent tumors after definitive chemotherapy and radiotherapy. J Thorac Cardiovasc Surg 2002;123:175-183.
27.张旭红,韩秀,王慧涵.205例食管癌单纯外照射疗效分析.实用肿瘤学杂志,2003,l7(1):52-53.
28. Minsky BD, Pajak T, Ginsberg RJ, et al. INT 0123 (RTOG 94-05) Phase III trial of combined modality therapy for esophageal cancer: high dose (64.8 Gy) vs. standard dose (50.4 Gy) radiation therapy. J Clin Oncol 2004:22:45-52.
29. Kelsen DP, Ginsberg R, Pajak TF, et al. Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer.N Engl J Med 1998;339:1979-1984.
30. Kelsen DP, Winter KA, Gnderson LL, et al. Long-term results of RTOG trial 8911(USA Intergroup 113): a random assignment trial comparison of chemotherapy followed by surgery compared with surgery alone for esophageal cencer. J Clin Oncol.2007;25(24):3719-3725.
31.范育伟,齐立伟,蒋晓东,陈年春,李佳.同步放化疗或单纯放疗治疗食管癌的疗效观察.肿瘤基础与临床,2009,22(6):492-494.
32.杨世朋.食管癌术后放疗与化放疗的疗效比较.工企医刊,2010,1:38-39.
33. Homs, M.Y., et al., Single-dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: multicentre randomised trial. Lancet, 2004. 364(9444): p. 1497-504.
34. Ilson, D.H., et al., Phase II trial of weekly irinotecan plus cisplatin in advanced esophageal cancer. J Clin Oncol, 1999. 17(10): p. 3270-5.
35. Ross, W.A., et al., Evolving role of self-expanding metal stents in the treatment of malignant dysphagia and fistulas. Gastrointest Endosc, 2007. 65(1): p. 70-6.
36. Shin, J.H., et al., Comparison of temporary and permanent stent placement with concurrent radiation therapy in patients with esophageal carcinoma. J VascInterv Radiol, 2005. 16(1): p. 67-74.
37.刘平,李启驹.外科治疗食管、贲门癌预后与年龄的关系.河南肿瘤学杂志,2003,16(6): 411-413.
38.刘平贺,洪亮.食管癌三野清扫术后患者的生活质量观察.中国医药指南,2008,6(21):130-132.
39.黄留保等.食管癌和贲门癌586例外科治疗结果分析.广西医学,2003,25(5):806-808.
40.张月琴,武晓燕,岳秀玲,梁小兵,许坚蔺,素琴.中晚期食管癌生存因素分析.肿瘤研究与临床,2005,17(增刊):25-26.
41.崔晓林、杜进祥.食管癌切除术后5年生存病例分析.山西医药杂志,2009,38(3):237-238.
42.徐皖湘等.食管癌化疗患者生存质量测定量表中文版的研制与考评.现代肿瘤医学, 2007,15(12):1792-1794.
43. Blazeby J M,Conroy T,Hammerlid E,et al.Clinical and psychometric validation of an EORTC questionnaire module, the EORTC QLQ-OES18,to assess quality of life in patients with oesophageal cancer[J].EurJ Cancer,2003,39(10):l384-1394.
44. Fagevik Olsen M,Larsson M,Hammerlid E,et al.Physical function and quality of life after thoracoabdominal oesophageal resection[J].Dig Surg,2005,22:63-68.
45.孙燕,等.临床肿瘤内科手册.第3版.北京:人民卫生出版社,1996.45.
46.陈于平,杨捷生等.食管癌术后远期生存患者的生存质量调查.医师进修杂志,2005,28(7)外科版:40-42.
47.王永岗,汪良骏,张庆斌,等.影响食管癌手术治疗患者预后的病理因素分析[ J ].实用癌症杂志, 2001, 16 (5) : 5162 517.
48. Weinberg JA.The intrathoraeie ympbatiea.In:Haagemen CD. ed.The Iymphatieis in cancer.1st ed.philadephia:W B saunders.72, 102 (3):245一249
49. Tabira Y,Okurna T,Kondo K,et al,Indications for three-field dissection followed by esophagectomy for advanced carcinoma of the thoracic esophagus [J].J Thorac Cardiovasc Surg,2001,117 (2):239-245
50. Tabira Y, Kitamura N, Yostfioka M,et al.Significance of three-field ymphacienectomy for carcinoma of the thoracic esophagus based on depth of tumor infiltration,lymph nodal involvement and survival rate[J].J Thorac Cardiovasc Surg,1999, 40:737一740
51. Kato H,Watanabe H,Tachimori Y, et al. Evaluation of abdominal lymph node dissection for thoracic esophageal carcinoma [J]. Ann Thorac Surg,2001,51 (6):931-935
52.林若柏,林培裘,周化,等.食管癌淋巴结转移规律的临床研究.中华肿瘤杂志,1996,18(4):292-295)(王永岗,汪良骏,张德超,等。胸段食管鳞癌淋巴结转移特点及临床意义.中华肿瘤杂志,2000, 22(3):241 -243
53.卫功铨食管外科手术技巧.北京:中国科学技术出版社,2000.76
54. Taclashi Nishimaki, Otsuo Tanaka, Tsutomu Suzuki, et al. Patterns of Lymphatics Spread in Thoracic Esophageal Cancer. Cancer,1994, 74(1):4-11
55.谢映涛,王树钦,黄金球,等.影响胸段食管鳞癌切除术预后的因素.中华胃肠外科杂志,2004, 7( 6): 453-455.
56.张逊.食管癌TNM分期的现状和发展趋势[J].中华肿瘤杂志,2004, 26(11):641-644
57.刘福善.食管癌贲门癌术后化疗对生存期和生活质量影响的临床观察.甘肃医药,2009,28(2):116-117.
58. Ando N,lizuka T,Takagawa T,et al.A randomized trial of surgery with and without chemotherapy for localized squaraous carcinoma of the thoracic esophagus:the Japan Clinical Oncology Group Study.J Thorac Cardiovasc Surg,l997.1l4:205-209.
59.张从军,钱勇,马越峰,陈振东.DLF方案化疗对食管癌患者生活质量的影响.现代肿瘤医学,2007,15(2):209-211.
60.侯良宝,杜俊甫,等.中晚期食管癌术后化疗和放疗综合治疗疗效观察.陕西肿瘤医学,2001,9(3):159-160,162.
61. Allure WH,Grifin SM,Watson A,et al. Guidelines for the management of oesophageal and gastric cancer.Gut,2002,50 Suppl V :vl-v23.
2.江吕泉,孙江,陈健.食管癌患者术后生存十年以上回顾分析.中国癌症杂志,2001,11(4):322-324.
3.木拉尔.食管癌X线钡餐造影检查.中外医疗,2009,28(34):181.
4.彭兴建,李蓉.105例早期食管癌X线表现及临床分析.现代临床医学,2009,35(1):62-63.
5.吴恩惠,尚克牛.中华影像医学消化系统卷[M].北京:人民卫生出版社,2002.65-66.
6.黄少宇,罗建光,王远波.螺旋CT扫描在食管癌术前分期评估中的价值.中国现代医药杂志,2009,11(7): 122-123.
7.祝淑钗,李任,李娟,邱嵘,韩春,万钧.非手术治疗胸段食管癌临床分期与预后关系的初步探讨.中华放射肿瘤学杂志2004,13:189-192.
8.陈德玉,欧阳卫平.胸部CT扫描对食管癌放疗计划的价值[J].江苏大学学报(医学版),2004,14(2):130-132.
9.王振军,郑琳.中晚期食管癌术前CT分期的临床应用价值.中国煤炭工业医学杂志,2006 9(8):867-867.
10.刘明,李彩英,万欣,彰俊杰,万钧.304例放射治疗为主的食管癌CT分期研究.中华放射肿瘤学杂志,2004, 13(1):18-20.
11.高献书,陈坤,周志国,时高峰,张萍,万钧.放射治疗食管癌CT分期的研究.河北医科大学学报,2003,24(3):153-154.
12. Weavera SR, Blackshawa GR, Lewis WG, et al. Comparison of special interest computed tomography, endosonography and histopathological stage of oesophageal cancer. Clinical[J]. Clin Radiol,2004, 59(6):499- 504
13. Schirmer CC, Osvaldt AB, Gurski RR, et al. Efficacy of computedaxial tomography in the evaluation of the involvement of the respiratory tract in patients with squamous cell carcinoma of esophagus[J]. Dis Esophagus, 1999, 12(3):196-201
14.仝国林.食管拉网在早期食管贲门癌诊治中的应用.中国误诊学杂志,2003,3(6):941-942.
15.曹丽君,熊里守.超声内镜检查在食管癌术前的诊断价值.南华大学学报:医学版,2008,36(2):179-181.
16.王秀茹.食管癌内镜诊断技术研究进展.河北医药,2007,29(7):731-733.
17.陈洁,张召珍.微探头超声内镜在食管癌术前分期中的应用分析.社区医学杂志,2009,23:61-62.
18.张逊.食管癌术前病理分期的诊断方法.肿瘤防治研究,2005,32(3):180-182.
19.李沧海.食管癌贲门癌外科治疗120例报告,实用医学杂志2006,13(24):4372.
20. Kumar S,Kumar A,Pawar DK.Thoracoscopic management of thoracic duct injury:Is there a place for conservatism[J].Postgrad Med,2004,50:57-59.
21. Wemyss-Holden SA,Launois B,Maddern GJ.Management of thoracic duct injuries after oesophagectomy[J].BrSurg,2001,88:1442-1448.
22. Alexiou C,Watson M,Beggs D,et al.Chylothorax following oesophagogastrectomy for malignant disease[J].Eur Cardiothorac Surg,1998,14:460-466.
23. Steyerberg EW, Neville BA, Kopper LB, Lemmens VE, et al. Surgical mortality in patients with esophageal cancer: development and validation of a simple risk score. J Clin Oncol 2006;24 (26):4277-4284.
24. De Hoyos A, Litle VR, and Luketich JD. Minimally invasive esophagectomy. Surg Clin North Am 2005;85 (3): 631-647.
25. Hofstetter WL. Lymph Node Dissection in Esophageal Cancer. Current Therapies in Thoracic and Cardiovascular Surgery, edited by SC Yang and DE Cameron. Mosby, Inc., Philadelphia, Pennsylvania, pp. 360-363, 2004.
26. Swisher SG, Wynn P, Putnam JB, Mosheim MB, et al. Salvage esophagectomy for recurrent tumors after definitive chemotherapy and radiotherapy. J Thorac Cardiovasc Surg 2002;123:175-183.
27.张旭红,韩秀,王慧涵.205例食管癌单纯外照射疗效分析.实用肿瘤学杂志,2003,l7(1):52-53.
28. Minsky BD, Pajak T, Ginsberg RJ, et al. INT 0123 (RTOG 94-05) Phase III trial of combined modality therapy for esophageal cancer: high dose (64.8 Gy) vs. standard dose (50.4 Gy) radiation therapy. J Clin Oncol 2004:22:45-52.
29. Kelsen DP, Ginsberg R, Pajak TF, et al. Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer.N Engl J Med 1998;339:1979-1984.
30. Kelsen DP, Winter KA, Gnderson LL, et al. Long-term results of RTOG trial 8911(USA Intergroup 113): a random assignment trial comparison of chemotherapy followed by surgery compared with surgery alone for esophageal cencer. J Clin Oncol.2007;25(24):3719-3725.
31.范育伟,齐立伟,蒋晓东,陈年春,李佳.同步放化疗或单纯放疗治疗食管癌的疗效观察.肿瘤基础与临床,2009,22(6):492-494.
32.杨世朋.食管癌术后放疗与化放疗的疗效比较.工企医刊,2010,1:38-39.
33. Homs, M.Y., et al., Single-dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: multicentre randomised trial. Lancet, 2004. 364(9444): p. 1497-504.
34. Ilson, D.H., et al., Phase II trial of weekly irinotecan plus cisplatin in advanced esophageal cancer. J Clin Oncol, 1999. 17(10): p. 3270-5.
35. Ross, W.A., et al., Evolving role of self-expanding metal stents in the treatment of malignant dysphagia and fistulas. Gastrointest Endosc, 2007. 65(1): p. 70-6.
36. Shin, J.H., et al., Comparison of temporary and permanent stent placement with concurrent radiation therapy in patients with esophageal carcinoma. J VascInterv Radiol, 2005. 16(1): p. 67-74.
37.刘平,李启驹.外科治疗食管、贲门癌预后与年龄的关系.河南肿瘤学杂志,2003,16(6): 411-413.
38.刘平贺,洪亮.食管癌三野清扫术后患者的生活质量观察.中国医药指南,2008,6(21):130-132.
39.黄留保等.食管癌和贲门癌586例外科治疗结果分析.广西医学,2003,25(5):806-808.
40.张月琴,武晓燕,岳秀玲,梁小兵,许坚蔺,素琴.中晚期食管癌生存因素分析.肿瘤研究与临床,2005,17(增刊):25-26.
41.崔晓林、杜进祥.食管癌切除术后5年生存病例分析.山西医药杂志,2009,38(3):237-238.
42.徐皖湘等.食管癌化疗患者生存质量测定量表中文版的研制与考评.现代肿瘤医学, 2007,15(12):1792-1794.
43. Blazeby J M,Conroy T,Hammerlid E,et al.Clinical and psychometric validation of an EORTC questionnaire module, the EORTC QLQ-OES18,to assess quality of life in patients with oesophageal cancer[J].EurJ Cancer,2003,39(10):l384-1394.
44. Fagevik Olsen M,Larsson M,Hammerlid E,et al.Physical function and quality of life after thoracoabdominal oesophageal resection[J].Dig Surg,2005,22:63-68.
45.孙燕,等.临床肿瘤内科手册.第3版.北京:人民卫生出版社,1996.45.
46.陈于平,杨捷生等.食管癌术后远期生存患者的生存质量调查.医师进修杂志,2005,28(7)外科版:40-42.
47.王永岗,汪良骏,张庆斌,等.影响食管癌手术治疗患者预后的病理因素分析[ J ].实用癌症杂志, 2001, 16 (5) : 5162 517.
48. Weinberg JA.The intrathoraeie ympbatiea.In:Haagemen CD. ed.The Iymphatieis in cancer.1st ed.philadephia:W B saunders.72, 102 (3):245一249
49. Tabira Y,Okurna T,Kondo K,et al,Indications for three-field dissection followed by esophagectomy for advanced carcinoma of the thoracic esophagus [J].J Thorac Cardiovasc Surg,2001,117 (2):239-245
50. Tabira Y, Kitamura N, Yostfioka M,et al.Significance of three-field ymphacienectomy for carcinoma of the thoracic esophagus based on depth of tumor infiltration,lymph nodal involvement and survival rate[J].J Thorac Cardiovasc Surg,1999, 40:737一740
51. Kato H,Watanabe H,Tachimori Y, et al. Evaluation of abdominal lymph node dissection for thoracic esophageal carcinoma [J]. Ann Thorac Surg,2001,51 (6):931-935
52.林若柏,林培裘,周化,等.食管癌淋巴结转移规律的临床研究.中华肿瘤杂志,1996,18(4):292-295)(王永岗,汪良骏,张德超,等。胸段食管鳞癌淋巴结转移特点及临床意义.中华肿瘤杂志,2000, 22(3):241 -243
53.卫功铨食管外科手术技巧.北京:中国科学技术出版社,2000.76
54. Taclashi Nishimaki, Otsuo Tanaka, Tsutomu Suzuki, et al. Patterns of Lymphatics Spread in Thoracic Esophageal Cancer. Cancer,1994, 74(1):4-11
55.谢映涛,王树钦,黄金球,等.影响胸段食管鳞癌切除术预后的因素.中华胃肠外科杂志,2004, 7( 6): 453-455.
56.张逊.食管癌TNM分期的现状和发展趋势[J].中华肿瘤杂志,2004, 26(11):641-644
57.刘福善.食管癌贲门癌术后化疗对生存期和生活质量影响的临床观察.甘肃医药,2009,28(2):116-117.
58. Ando N,lizuka T,Takagawa T,et al.A randomized trial of surgery with and without chemotherapy for localized squaraous carcinoma of the thoracic esophagus:the Japan Clinical Oncology Group Study.J Thorac Cardiovasc Surg,l997.1l4:205-209.
59.张从军,钱勇,马越峰,陈振东.DLF方案化疗对食管癌患者生活质量的影响.现代肿瘤医学,2007,15(2):209-211.
60.侯良宝,杜俊甫,等.中晚期食管癌术后化疗和放疗综合治疗疗效观察.陕西肿瘤医学,2001,9(3):159-160,162.
61. Allure WH,Grifin SM,Watson A,et al. Guidelines for the management of oesophageal and gastric cancer.Gut,2002,50 Suppl V :vl-v23.