CAJ | 학술논문

目的研究胸段食管鳞癌根治术后淋巴结转移特点及对预后的影响,探讨合理的术后辅助治疗方案.方法应用Spearman相关分析、Cox模型及Kaplan-Meier法等对204例患者的临床及随访资料进行多因素分析.结果 204例患者中淋巴结转移率为40.2%(82/204),转移度为7.57%(166/2193).相关因素分析显示:肿瘤浸润深度、肿瘤长度及细胞分化程度与淋巴结转移有关(χ2=17.466,11.494.6.767,P<0.05);患者年龄、肿瘤部位与淋巴结转移无关(χ2=1.086,3.897,P>0.05).生存分析显示:淋巴结转移个数<4枚组与≥4枚组1、3、5年生存率比较差异有统计学意义(χ2=4.493,4.494,4.450,P<0.05);有淋巴结转移较无淋巴结转移者易发生复发及转移(r=-2.060,-4.296,P<0.05).多因素分析显示:病理分期、分化程度、术后辅助治疗是独立的预后因素.结论肿瘤长度、浸润深度及细胞分化程度与胸段食管鳞癌术后淋巴结转移有关,淋巴结转移状态及转移个数可影响预后.术后口服化疗药物对无淋巴结转移者生存有益.
목적 연구흉단식관린암근치술후림파결전이특점급대예후적영향,탐토합리적술후보조치료방안.방법 응용Spearman상관분석、Cox모형급Kaplan-Meier법등대204례환자적림상급수방자료진행다인소분석.결과 204례환자중림파결전이솔위40.2%(82/204),전이도위7.57%(166/2193).상관인소분석현시:종류침윤심도、종류장도급세포분화정도여림파결전이유관(χ2=17.466,11.494.6.767,P<0.05);환자년령、종류부위여림파결전이무관(χ2=1.086,3.897,P>0.05).생존분석현시:림파결전이개수<4매조여≥4매조1、3、5년생존솔비교차이유통계학의의(χ2=4.493,4.494,4.450,P<0.05);유림파결전이교무림파결전이자역발생복발급전이(r=-2.060,-4.296,P<0.05).다인소분석현시:병리분기、분화정도、술후보조치료시독립적예후인소.결론 종류장도、침윤심도급세포분화정도여흉단식관린암술후림파결전이유관,림파결전이상태급전이개수가영향예후.술후구복화료약물대무림파결전이자생존유익.
Objective To investigate the features of lymph node metastasis and its effects on the prognosis of patients after radical operation for thoracic esophageal squamous cell cancer, and investigate the reasonable postoperative adjuvant protocol. Methods Multivariate analysis of the clinical data of 204 patients was carried out by Spearman correlation analysis, Cox model and Kaplan-Meier method. Results The lymph node metastasis rate was 40.2% (82/204), and 166 out of 2193 dissected lymph nodes had metastasis with the rate of 7.57%. The analysis of related factors revealed that the invasion depth, tumor length and differentiation grade were significantly associated with the postoperative lymph node metastasis (χ2 = 17.466, 11.494, 6.767, P <0.05), while age, tumor site were not significantly correlated with the postoperative lymph node metastasis (χ2=1.086, 3.897, P > 0.05). Kaplan-Meier analysis showed that the 1-, 3-, 5-year survival rates of patients with < 4 lymph nodes metastasis were significantly higher than those with ≥4 lymph nodes metastasis (χ2=4.493, 4.494, 4.450, P < 0.05). The recurrence and metastasis were more often occurred in patients with lymph node metastasis compared with those without lymph node metastasis (r=-2.060, -4.296, P <0.05). Multivariate analysis confirmed that the pathological stage, tumor differentiation grade, and the postoperative adjuvant treatment were the independent prognostic factors. Conclusions The invasion depth, tumor length and differentiation grade are significantly associated with the postoperative lymph node metastasis. The lymph node metastasis state and the number of involved lymph nodes affect the prognosis of patients. Oral administration of 5-FU is benefit to the patients without lymph node metastasis.