Siewert Ⅱ型和Ⅲ型食管胃结合部腺癌预后因素及淋巴结转移率影响因素分析

Analysis of prognostic factors and influencing factors of lymph node ratio in patients with Siewert Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction

    摘要
  • 摘要: 目的:探讨SiewertⅡ型和Ⅲ型食管胃结合部腺癌(AEG)患者预后因素及淋巴结转移率(LNR)影响因素。
    方法:采用回顾性病例对照研究方法。收集2010年1月至2011年1月安徽医科大学第一附属医院收治的444例Siewert Ⅱ型和Ⅲ型AEG患者的临床病理资料。444例患者均行根治性AEG D2淋巴结清扫术，淋巴结清扫范围为下纵隔＋食管裂孔周围+腹腔淋巴结。采用电话和门诊方式进行随访，术后2年内每3个月随访1次，2～5年间每6个月随访1次，5年后每12个月随访1次，了解患者预后情况。随访时间截至2016年10月。观察指标：(1)随访和生存情况。(2)影响Siewert Ⅱ型和Ⅲ型AEG患者预后的单因素和多因素分析。(3) 影响Siewert Ⅱ型和Ⅲ型AEG患者LNR的单因素和多因素分析。采用KaplanMeier法绘制生存曲线和计算生存率。单因素分析采用Logrank检验，多因素分析采用Cox比例风险模型。
    结果:(1)随访和生存情况：444例Siewert Ⅱ型和Ⅲ型AEG患者均获得术后随访，随访时间为1～ 81个月，中位随访时间为52个月。444例Siewert Ⅱ型和Ⅲ型AEG患者术后1、3、5年总体生存率分别为93.2%、60.3%、45.7%。(2)影响Siewert Ⅱ型和Ⅲ型AEG患者的预后因素分析：单因素分析结果显示：肿瘤直径、肿瘤分化程度、肿瘤浸润深度、pN分期和LNR分期是影响Siewert Ⅱ型和Ⅲ型AEG患者预后的相关因素，差异均有统计学意义(x2=12.332，5.898，36.045，38.847，46.464，P<0.05)。多因素分析结果显示：肿瘤浸润深度和LNR分期是Siewert Ⅱ型和Ⅲ型AEG患者预后的独立影响因素(RR=1.393，1.411，95%可信区间：1.137～1.708，1.106～1.801，P<0.05)。(3)Siewert Ⅱ型和Ⅲ型AEG患者LNR的影响因素分析：单因素分析结果显示：肿瘤直径、肿瘤分化程度、肿瘤浸润深度是影响Siewert Ⅱ型和Ⅲ型AEG患者LNR的相关因素，差异均有统计学意义(x2=20.077，12.618，36.586，P<0.05)。多因素分析结果显示：肿瘤直径、肿瘤分化程度、肿瘤浸润深度是Siewert Ⅱ型和Ⅲ型AEG患者LNR的独立影响因素(OR=0.684，0.688，0.788，95%可信区间：0.485～0.965，0.505～0.936，0.687～0.903，P<0.05)。
    结论:肿瘤浸润深度和LNR分期是Siewert Ⅱ型和Ⅲ型AEG患者预后的独立影响因素。肿瘤直径、肿瘤分化程度、肿瘤浸润深度是Siewert Ⅱ型和Ⅲ型AEG患者LNR的独立影响因素。

     

    Abstract: Objective:To investigate the prognostic factors and influencing factors of lymph node ratio (LNR) in patients with Siewert Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction (AEG).
    Methods:The retrospective casecontrol study was conducted. The clinicopathological data of 444 patients with Siewert Ⅱ and Ⅲ AEG who were admitted to the First Affiliated Hospital of Anhui Medical University between January 2010 and January 2011 were collected. All the 444 patients underwent radical D2 lymph node dissection, extent of lymph node dissection was inferior mediastinum, around the esophageal hiatus and celiac lymph node. Followup using telephone interview and outpatient examination was performed to detect patients′ prognosis once every 3 months within 2 years postoperatively, once every 6 months from 2 years to 5 years postoperatively and once every 12 months after 5 years up to October 2016. Observation indicators: (1) followup and survival situations; (2) univariate and multivariate factors analysis affecting prognosis of patients with Siewert Ⅱ and Ⅲ AEG; (3) univariate and multivariate factors analysis affecting LNR of patients with Siewert Ⅱ and Ⅲ AEG. The survival curve and rate were respectively drawn and calculated by the KaplanMeier method. The univariate analysis and multivariate analysis were respectively done using the Logrank test and the COX regression model.
    Results:(1) Followup and survival situations: all the 444 patients were followed up for 1-81 months, with a median time of 52 months. The 1, 3, 5year overall survival rates of 444 patients were respectively 93.2%, 60.3% and 45.7%. (2) Factors analysis affecting prognosis of patients with Siewert Ⅱ and Ⅲ AEG: results of univariate analysis showed that tumor diameter, tumor differentiation, invasion depth of tumor, pN staging and staging of LNR were related factors affecting prognosis of patients with Siewert Ⅱ and Ⅲ AEG, with statistically significant differences (x2=12.332, 5.898, 36.045, 38.847, 46.464, P<0.05). Results of multivariate analysis showed that invasion depth of tumor and staging of LNR were independent factors affecting prognosis of patients with Siewert Ⅱ and Ⅲ AEG ［RR=1.393, 1.411, 95% confidence interval (CI): 1.137-1.708, 1.106-1.801, P<0.05］. (3) Factors affecting LNR of patients with Siewert Ⅱ and Ⅲ AEG: results of univariate analysis showed that tumor diameter, tumor differentiation and invasion depth of tumor were related factors affecting LNR of patients with Siewert Ⅱ and Ⅲ AEG, with statistically significant differences (x2=20.077, 12.618, 36.586, P<0.05). Results of multivariate analysis showed that tumor diameter, tumor differentiation and invasion depth of tumor were independent factors affecting LNR of patients with Siewert Ⅱ and Ⅲ AEG (OR=0.684, 0.688, 0.788, 95% CI: 0.485-0.965, 0.505-0.936, 0.687-0.903, P<0.05).
    Conclusions:The invasion depth of tumor and staging of LNR are independent factors affecting prognosis of patients with Siewert Ⅱ and Ⅲ AEG. Tumor diameter, tumor differentiation and invasion depth of tumor are independent factors affecting LNR of patients with Siewert Ⅱ and Ⅲ AEG.

     

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