胸段食管鳞癌外科治疗及预后分析（附2 766例报告）

倪琨涵; 李昌顶; 姜龙琳; 何文武; 王程浩; 王康宁; 刘光源; 彭林; 方强; 肖文光; 乔良; 王奇峰; 韩泳涛; 冷雪峰

doi:10.3760/cma.j.cn115610-20230927-00120

胸段食管鳞癌外科治疗及预后分析（附2 766例报告）

Surgical treatment and prognosis analysis of thoracic esophageal squamous cell carcinoma: a report of 2 766 cases

摘要

摘要:
目的探讨胸段食管鳞癌外科治疗及预后。
方法采用回顾性队列研究方法。收集2010年1月至2017年12月四川省肿瘤医院收治的2 766例胸段食管鳞癌患者的临床病理资料；男2 256例,女510例；年龄为（62±8）岁。患者均行外科手术治疗。观察指标：（1）治疗情况。（2）术后并发症情况。（3）术后生存情况。正态分布的计量资料以x±s表示,偏态分布的计量资料以M（Q₁,Q₃）表示。计数资料以绝对数或百分率表示。采用Kaplan‑Meier法绘制生存曲线并计算生存率,Log‑Rank检验进行生存分析。
结果（1）治疗情况。2 766例患者中,新辅助治疗52例；1 444例行开放手术（其中44例中转开胸手术）,1 322例行微创食管切除术；手术方式为McKeown、Ivor‑Lewis、Sweet分别为1 991、729、46例；术后辅助治疗1 271例。2 766例患者淋巴结转移数目为2.1（0,3.0）枚,淋巴结清扫数目为（22±12）枚,R₀切除率为94.722%（2 620/2 766）,手术时间为（237±66）min。（2）术后并发症情况。2 766例患者术后总并发症发生率为25.850%（715/2 766）,术后肺炎和吻合口瘘发生率最高,分别为8.604%（238/2 766）和7.484%（207/2 766）。同一例患者可合并≥2种术后并发症。（3）术后生存情况。2 766例患者1、3、5年总生存率分别为86.2%、57.5%、46.8%。进一步分析,510例女性患者和2 256例男性患者5年总生存率分别为62.0%和43.3%,两者比较,差异有统计学意义（χ²=48.94,P<0.05）。693例胸上段、1 479例胸中段、594例胸下段食管鳞癌患5年总生存率分别为49.5%、46.7%、44.1%, 3者比较,差异无统计学意义（χ²=3.21,P>0.05）。68例0期、259例Ⅰ期、885例Ⅱ期、1 222例Ⅲ期、332例Ⅳ期患者5年总生存率分别为95.6%、76.4%、61.4%、35.6%、14.5%,5者比较,差异有统计学意义（χ²=500.40,P<0.05）。1 444例行开放手术和1 322例行微创食管切除术患者5年总生存率分别为42.5%和51.8%,两者比较,差异有统计学意义（χ²=31.29,P<0.05）。1 991例行McKeown、729例行Ivor‑Lewis、46例行Sweet患者5年总生存率分别为49.5%、41.2%、32.3%,3者比较,差异有统计学意义（χ²=19.19,P<0.05）。
结论微创食管切除术与开放手术比较,McKeown方式与Ivor‑Lewis和Sweet手术方式比较,均可为胸段食管鳞癌患者带来生存获益。

Abstract:
Objective To investigate the surgical treatment and prognosis of thoracic esophageal squamous cell carcinoma (ESCC).
Methods The retrospective cohort study was conducted. The clinicopathological data of 2 766 patients with thoracic ESCC who were admitted to Sichuan Cancer Hospital & Institute from January 2010 to December 2017 were collected. There were 2 256 males and 510 females, aged (62±8)years. All patients underwent surgical treatment. Observation indicators: (1) treatment; (2) postoperative complications; (3) postoperative survival. Measurement data with normal distribution were represented as Mean±SD. Measurement data with skewed distribution were represented as M(Q₁,Q₃). Count data were described as absolute numbers or percentages. The Kaplan‑Meier method was used to draw survival curve and calculate survival rate, and the Log‑Rank test was used for survival analysis.
Result (1) Treatment. Fifty‑two of the 2 766 patients underwent neoadjuvant therapy. There were 1 444 patients undergoing open surgery, including 44 cases conversion to thoracotomy, and there were 1 322 patients undergoing minimally invasive esophagectomy. There were 1 991, 729 and 46 cases with McKeown, Ivor‑Lewis and Sweet esophagectomy, respectively. One thousand two hundred and seventy‑one of the 2 766 patients underwent postoperative adjuvant therapy. The number of lymph node metastases, the number of lymph node dissected, rate of R₀ resection, operation time of 2 766 patients were 2.1(0,3.0), 22±12, 94.722%(2 620/2 766), (237±66)minutes. (2) Postoperative complications. The overall incidence of postoperative complications was 25.850%(715/2 766). The top two postoperative complications were pneumonia and anastomotic fistula, with incidence rates of 8.604%(238/2766) and 7.484%(207/2766), respectively. One patient may have more than two kinds of postoperative complications. (3) Postoperative survival. The 1‑, 3‑and 5‑year overall survival rates of 2 766 patients were 86.2%, 57.5% and 46.8%, respectively. Further analysis indicated that the 5‑year overall survival rates of 510 female patients and 2 256 male patients were 62.0% and 43.3%, respectively, showing a significant difference between them (χ²=48.94, P<0.05). The 5‑year overall survival rates of 693 cases with upper thoracic ESCC, 1 479 cases with middle thoracic ESCC and 594 cases with lower thoracic ESCC were 49.5%, 46.7% and 44.1%, respectively, showing no significant difference among them (χ²=3.21, P>0.05). The 5‑year overall survival rates of 68 cases with stage 0 thoracic ESCC, 259 cases with stage Ⅰ esophageal ESCC, 885 cases with stage Ⅱ thoracic ESCC, 1 222 cases with stage Ⅲ thoracic ESCC, and 332 cases with stage Ⅳ thoracic ESCC were 95.6%, 76.4%, 61.4%, 35.6%, and 14.5%, respectively, showing a significant difference among them (χ²=500.40, P<0.05). The 5‑year overall survival rates of 1 444 patients undergoing open esophagectomy and 1 322 patients undergoing minimally invasive esophagectomy were 42.5% and 51.8%, respectively, showing a significant difference between them (χ²=31.29, P<0.05). The 5‑year overall survival rates of 1 991 cases undergoing McKeown esophagectomy, 729 cases undergoing Ivor‑Lewis esophagectomy, and 46 cases undergoing Sweet esophagectomy were 49.5%, 41.2%, and 32.3%, respectively, showing a significant difference among them (χ²=19.19, P<0.05).
Conclusions Compared with open esophagectomy, minimally invasive esophagectomy brings survival benefits to patients with thoracic esophageal ESCC. Among different esophagectomy methods, the McKeown esophagectomy has also brought survival benefits to patients with esophageal ESCC compared to the Ivor‑Lewis esophagectomy and the Sweet esophagectomy.

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