肿瘤直径对进展期食管鳞癌患者Ivor-Lewis术后预后的影响

Effects of tumor diameter on the prognosis of patients with advanced esophageal squamous cell carcinoma after IvorLewis surgical resection

    摘要
  • 摘要: 目的:探讨肿瘤直径对进展期食管鳞癌患者Ivor-Lewis术后预后的影响。
    方法:回顾性分析2005年1月至2008年12月天津医科大学肿瘤医院行Ivor-Lewis术的254例进展期食管鳞癌患者的临床病理资料。采用门诊、电话及信件方式进行随访，随访时间截至2013年12月。采用Kaplan-Meier法绘制生存曲线，Log-rank检验进行生存分析。采用受试者工作特征曲线确定肿瘤直径评估患者预后的最佳截点值。采用χ2检验进行单因素分析，COX比例风险模型进行多因素分析。
    结果:254例患者中，223例术后获得随访，随访率为87.80%(223/254)，中位随访时间为30个月(3～108个月)。223例患者总体中位生存时间为27个月，1、3、5年生存率分别为72.7%、42.2%、31.3%。肿瘤直径评估患者预后的最佳截点值为3.5 cm。肿瘤直径≤3.5 cm患者中位生存时间为36个月，5年累积生存率为39.3%；肿瘤直径> 3.5 cm患者中位生存时间为18个月，5年累积生存率为25.4%，两者生存情况比较，差异有统计学意义(χ2=9.494，P<0.05)。单因素分析结果显示：患者年龄、肿瘤直径、肿瘤浸润深度、淋巴结转移和术后辅助治疗是影响进展期食管鳞癌患者Ivor-Lewis术后预后的相关因素(χ2=4.459，9.494，6.993，10.382，5.507，P<0.05)。多因素分析结果显示：肿瘤直径>3.5 cm、有淋巴结转移和术后无辅助治疗是影响进展期食管鳞癌患者Ivor-Lewis术后预后的独立危险因素(HR=1.631，1.681，0.677，95%可信区间：1.151～2.312， 1.198～2.358，0.487～0.942，P<0.05)。159例无淋巴结转移的Ivor-Lewis术后进展期食管鳞癌患者中，肿瘤直径≤3.5 cm患者中位生存时间为49个月，5年累积生存率为46.4%；肿瘤直径>3.5 cm患者中位生存时间为23个月，5年累积生存率为32.0%，两者生存情况比较，差异有统计学意义(χ2=6.412，P< 0.05)。
    结论:肿瘤直径>3.5 cm、有淋巴结转移和术后无辅助治疗是影响进展期食管鳞癌患者Ivor-Lewis术后预后的独立危险因素。对于无淋巴结转移患者，肿瘤直径对患者预后有评估价值。

     

    Abstract: Objective:To investigate the tumor diameter on the prognosis of patients with advanced esophageal squamous cell carcinoma(ESCC) after IvorLewis surgical resection.
    Methods:The clinical data of 254 patients with advanced ESCC who received IvorLewis surgical resection at the Affiliated Hospital of Tianjin Medical University from January 2005 to December 2008 were retrospectively analyzed. All the patients were followed up via outpatient examination, telephone interview and correspondence till December 2013. Survival curve was drawn by the KaplanMeier method, and survival rate was analyzed using the Logrank test. Receiveroperatingcharacteristic (ROC) curve analysis was used to determine the appropriate cutoff value of tumor size. Univariate and multivariate analysis were done using the chisquare test and COX regression model.
    Results:Of 254 patients, 223 patients were followed up for a median time of 30 months (range, 3-108 months) with a followup rate of 87.80%(223/254). The median total survival time was 27 months, and the 1, 3, 5year overall survival rates were 72.7%, 42.2% and 31.3%, respectively. ROC analysis showed that the appropriate cutoff value of tumor diameter was 3.5 cm. The median survival time and 5year survival rate were 36 months and 39.3% in patients with tumor diameter≤3.5 cm and 18 months and 25.4% in patients with tumor diameter>3.5 cm, respectively, with a significant difference (χ2=9.494, P<0.05). The results of univariate analysis showed that the age, tumor diameter, depth of tumor invasion, lymph node metastasis and postoperative adjuvant therapy were related factors affecting the prognosis of patients with advanced ESCC after IvorLewis surgical resection (χ2=4.459, 9.494, 6.993, 10.382, 5.507, P<0.05). The results of multivariate analysis showed that tumor diameter>3.5 cm, lymph node metastasis and no postoperative adjuvant therapy were the independent factors affecting the prognosis of patients with advanced ESCC after IvorLewis surgical resection (HR=1.631, 1.681, 0.677, 95% confidence interval: 1.151-2.312, 1.198-2.358, 0.487-0.942, P<0.05). Of 159 patients without postoperative lymph node metastasis, median survival time and 5year accumulated survival rate were 49 months and 46.4% in patients with tumor diameter≤3.5 cm and 23 months and 32.0% in patients with tumor diameter>3.5 cm, respectively, with a significant difference (χ2=6.412, P<0.05).
    Conclusions:The tumor diameter>3.5 cm, lymph node metastasis and no postoperative adjuvant therapy are the independent factors affecting the prognosis of patients with advanced ESCC after IvorLewis surgical resection, meanwhile there is an assessed value of tumor diameter on the prognosis of patients without lymph node metastasis.

     

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