食管鳞状细胞癌不同治疗模式的疗效分析
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摘要
目的探讨不同治疗模式对食管鳞状细胞癌患者预后的影响。方法回顾性分析2010年1月至2015年12月367例治疗的食管癌患者的临床资料,通过采取门诊和电话随访,共随访347例,统计患者生存时间,收集性别、年龄、治疗模式、病变部位、分化程度、病变长度、脉管癌栓、神经侵犯、TNM分期等预后影响因素,通过Cox回归分析法和Kaplan-Meier法分析食管癌患者生存率变化的影响因素。结果单因素分析显示,单纯手术、手术+化疗、手术+放疗、手术+放疗+化疗治疗的3年生存率分别是51.9%、73.9%、74.5%、61.6%,单纯手术组3年生存率显著低于术后综合治疗组(P<0.05)。治疗模式和TNM分期是影响食管癌患者3年生存率的主要因素(P<0.05);Cox回归多因素分析显示,治疗模式和TNM分期是影响食管癌患者预后的独立影响因素(P<0.05)。结论食管癌术后患者建议行综合治疗,治疗模式和TNM分期是影响食管癌患者生存的独立影响因素。
Objective To investigate the effects of different treatment modes on the prognosis of patients with esophageal squamous cell carcinoma(ESCC).Methods A retrospective analysis was made on 367 ESCC patients treated from January 2010 to December 2015.The survival time of 347 patients was counted through outpatients and telephone follow-up.The prognostic factors such as gender,age,treatment mode,lesion location,differentiation degree,lesion length,vascular tumor thrombus,nerve invasion,TNM stage were collected,and the influencing factors of survival rate changes were analyzed by Cox regression analysis and Kaplan-Meier method.Results Univariate analysis showed that the 3-year survival rates were 51.9%,73.9%,74.5%,61.6% in surgery alone group,surgery plus chemotherapy group,surgery plus radiotherapy group,surgery plus radiotherapy and chemotherapy group,respectively.The 3-year survival rate of simple surgery group was significantly lower than those of comprehensive treatment groups(P<0.05).Cox regression multivariate analysis showed that treatment mode and TNM staging were the independent influencing factors of prognosis in patients with esophageal cancer(P<0.05).Conclusion Comprehensive treatment is recommended for patients with esophageal cancer,and treatment mode and TNM staging are the independent influencing factors of patient′s survival.
Objective To investigate the effects of different treatment modes on the prognosis of patients with esophageal squamous cell carcinoma(ESCC).Methods A retrospective analysis was made on 367 ESCC patients treated from January 2010 to December 2015.The survival time of 347 patients was counted through outpatients and telephone follow-up.The prognostic factors such as gender,age,treatment mode,lesion location,differentiation degree,lesion length,vascular tumor thrombus,nerve invasion,TNM stage were collected,and the influencing factors of survival rate changes were analyzed by Cox regression analysis and Kaplan-Meier method.Results Univariate analysis showed that the 3-year survival rates were 51.9%,73.9%,74.5%,61.6% in surgery alone group,surgery plus chemotherapy group,surgery plus radiotherapy group,surgery plus radiotherapy and chemotherapy group,respectively.The 3-year survival rate of simple surgery group was significantly lower than those of comprehensive treatment groups(P<0.05).Cox regression multivariate analysis showed that treatment mode and TNM staging were the independent influencing factors of prognosis in patients with esophageal cancer(P<0.05).Conclusion Comprehensive treatment is recommended for patients with esophageal cancer,and treatment mode and TNM staging are the independent influencing factors of patient′s survival.
引文
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[16] 李娟,祝淑钗,王玉祥,等.375例食管癌三维适形放疗长期疗效分析[J].中华放射肿瘤学杂志,2012,21(4):334-338.
[2] Ma MQ,Zhang HD,Tang P,et al.Association of Kruppel-like factor 4 expression with the prognosis of esophageal squamous cell carcinoma patients[J].Int J Clin Exp Pathol,2014,7(10):6679-6685.
[3] Guo YC,Bao YH,Ma M,et al.Clinical significance of the correlation between PLCE 1 and PRKCA in esophageal inflammation and esophageal carcinoma[J].Oncotarget,2017,8(20):33285-33299.
[4] Shapiro J,ten Kate FJ,van Hagen P,et al.Residual esophageal cancer after neoadjuvant chemoradiotherapy frequently involves the mucosa and submucosa[J].Ann Surg,2013,258(5):678-689.
[5] Sun XB,Zhao DL,Liu Y,et al.The long-term spatial-temporal trends and burden of esophageal cancer in one high-risk area:A population-registered study in Feicheng,China[J].PLoS One,2017,12(3):e0173211.
[6] Zhang SS,Lei YY,Cai XL,et al.Preoperative serum fibrinogen is an independent prognostic factor in operable esophageal cancer[J].Oncotarget,2016,7(18):25461-25469.
[7] Park JW,Kim JH,Choi EK,et al.Prognosis of esophageal cancer patients with pathologic complete response after preoperative concurrent chemoradiotherapy[J].Int J Radiat Oncol Biol Phys,2011,81(3):691-697.
[8] Chen JW,Xie JD,Ling YH,et al.The prognostic effect of perineural invasion in esophageal squamous cell carcinoma[J].BMC Cancer,2014,14:313.
[9] Sheng LM,Ji YL,DuXH.Perineural invasion correlates with postoperative distant metastasis and poor overall survival in patients with pT1-3N0M0 esophageal squamous cell carcinoma[J].Onco Targets Ther,2015,8:3153-3157.
[10] Xu GH,Feng F,Liu Z,et al.Prognosis and progression of ESCC patients with perineural invasion[J].Sci Rep,2017,7:43828.
[11] Ning ZH,Zhao W,Li XD,et al.The status of perineural invasion predicts the outcomes of postoperative radiotherapy in locally advanced esophageal squamous cell carcinoma[J].Int J Clin Exp Pathol,2015,8(6):6881-6890.
[12] Gao AQ,Wang LL,Li J,et al.Prognostic value of perineural invasion in esophageal and esophagogastric junction carcinoma:A meta-analysis[J].Dis Markers,2016,2016:7340180.
[13] Kang XZ,Chen KN,Li YC,et al.Personalized targeted therapy for esophageal squamous cell carcinoma[J].World J Gastroenterol,2015,21(25):7648-7658.
[14] 王玉祥,祝淑钗,李娟,等.209例食管癌三维适行放疗疗效分析[J].中华放射肿瘤学杂志,2010,19(2):101-104.
[15] 邵秋月,谢淑萍,沈佳琴,等.食管癌放疗联合化疗患者营养状况相关性因素分析[J].中华全科医学,2017,15(9):1589-1591.
[16] 李娟,祝淑钗,王玉祥,等.375例食管癌三维适形放疗长期疗效分析[J].中华放射肿瘤学杂志,2012,21(4):334-338.