中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2010年
17期
1289-1294
,共6页
杨宏%武爱文%李子禹%步召德%张连海%吴晓江%宗祥龙%李双喜%陕飞%杨跃%季加孚
楊宏%武愛文%李子禹%步召德%張連海%吳曉江%宗祥龍%李雙喜%陝飛%楊躍%季加孚
양굉%무애문%리자우%보소덕%장련해%오효강%종상룡%리쌍희%협비%양약%계가부
胃食管结合部癌%外科手术%预后
胃食管結閤部癌%外科手術%預後
위식관결합부암%외과수술%예후
Gastroesophageal junction carcinoma%Surgical procedures,operative%Prognosis
目的 探讨影响胃食管结合部癌患者预后的临床病理因素.方法 回顾性分析1995年9月至2007年1月接受外科手术治疗的514例胃食管结合部癌患者的临床资料,统计分析患者临床病理因素和治疗措施对预后的影响.结果 全组514例患者,男性424例,女性90例,中位年龄63岁.全组1、3、5年生存率分别为74.8%、42.1%和29.1%.Kaplan-Meier法单因素分析显示,患者的性别、年龄与生存无明显相关性,而肿瘤大体分型、组织学类型、TNM分期、有无脉管癌栓及是否接受根治手术是影响患者预后的因素.经腹与经胸手术相比,两组患者的生存曲线未见显著差异(P＞0.05);对于分期≥Ⅱ期的患者,近端胃大部切除和全胃切除亦未显示生存差异(P＞0.05);而对于Ⅱ、Ⅲ期患者,术前化疗患者的预后要优于术前无化疗者(P＜0.05).采用Cox模型进行多因素分析显示,TNM分期和有无脉管癌栓是影响患者预后的独立因素.结论 TNM分期和有无脉管癌栓是影响患者预后的独立因素,对于Ⅱ、Ⅲ期患者,术前新辅助化疗可改善患者预后.手术应尽可能做到根治,并根据肿瘤的位置、大小、分期等因素选择合适的手术路径和切除范围.
目的 探討影響胃食管結閤部癌患者預後的臨床病理因素.方法 迴顧性分析1995年9月至2007年1月接受外科手術治療的514例胃食管結閤部癌患者的臨床資料,統計分析患者臨床病理因素和治療措施對預後的影響.結果 全組514例患者,男性424例,女性90例,中位年齡63歲.全組1、3、5年生存率分彆為74.8%、42.1%和29.1%.Kaplan-Meier法單因素分析顯示,患者的性彆、年齡與生存無明顯相關性,而腫瘤大體分型、組織學類型、TNM分期、有無脈管癌栓及是否接受根治手術是影響患者預後的因素.經腹與經胸手術相比,兩組患者的生存麯線未見顯著差異(P＞0.05);對于分期≥Ⅱ期的患者,近耑胃大部切除和全胃切除亦未顯示生存差異(P＞0.05);而對于Ⅱ、Ⅲ期患者,術前化療患者的預後要優于術前無化療者(P＜0.05).採用Cox模型進行多因素分析顯示,TNM分期和有無脈管癌栓是影響患者預後的獨立因素.結論 TNM分期和有無脈管癌栓是影響患者預後的獨立因素,對于Ⅱ、Ⅲ期患者,術前新輔助化療可改善患者預後.手術應儘可能做到根治,併根據腫瘤的位置、大小、分期等因素選擇閤適的手術路徑和切除範圍.
목적 탐토영향위식관결합부암환자예후적림상병리인소.방법 회고성분석1995년9월지2007년1월접수외과수술치료적514례위식관결합부암환자적림상자료,통계분석환자림상병리인소화치료조시대예후적영향.결과 전조514례환자,남성424례,녀성90례,중위년령63세.전조1、3、5년생존솔분별위74.8%、42.1%화29.1%.Kaplan-Meier법단인소분석현시,환자적성별、년령여생존무명현상관성,이종류대체분형、조직학류형、TNM분기、유무맥관암전급시부접수근치수술시영향환자예후적인소.경복여경흉수술상비,량조환자적생존곡선미견현저차이(P＞0.05);대우분기≥Ⅱ기적환자,근단위대부절제화전위절제역미현시생존차이(P＞0.05);이대우Ⅱ、Ⅲ기환자,술전화료환자적예후요우우술전무화료자(P＜0.05).채용Cox모형진행다인소분석현시,TNM분기화유무맥관암전시영향환자예후적독립인소.결론 TNM분기화유무맥관암전시영향환자예후적독립인소,대우Ⅱ、Ⅲ기환자,술전신보조화료가개선환자예후.수술응진가능주도근치,병근거종류적위치、대소、분기등인소선택합괄적수술로경화절제범위.
Objective To clarify the important clinicopathological and therapeutical factors affecting the prognosis of patients with gastroesophageal junction carcinoma. Methods Data of 514 cases with gastroesophageal junction carcinoma who underwent surgical treatment from September 1995 to January 2007 was retrospectively analyzed. Relevant prognostic factors were studied with univariate and multivariate analysis. Results For all 514 cases (424 men and 90 women), the median age was 63 years. The 1-, 3- and 5-year survival rates of this group were 74.8%, 42.1% and 29.1%, respectively. Gross type, TNM classification, histological type, vascular invasion and extent of surgical resection affected patients' survival remarkably. There was no significant difference in survival between operative approaches (via laparotomy or left thoracotomy) ( P ＞ 0.05 ). Long-term survival was similar between proximal subtotal gastrectomy and total gastrectomy in advanced cases ( P ＞ 0.05 ). For stage Ⅱ and Ⅲ tumors, patients with neoadjuvant chemotherapy had better prognosis than those without ( P ＜ 0.05 ). Cox multivariate regression analysis revealed TNM classification and vascular invasion were independent prognostic factors. Conclusions TNM classification and vascular invasion are independent prognostic factors for gastroesophageal junction carcinoma. Neoadjuvant chemotherapy may improve prognosis of the patients with stage Ⅱ and Ⅲ tumors.Radical resection should be achieved with rational surgical procedures tailored by tumor position, size,staging and so on.
