CAJ | 학술논문

目的探讨影响胸段食管癌切除术后患者预后的因素,以及淋巴结转移数目对患者预后和TNM分期标准的影响.方法对1224例非手术死亡的食管癌切除术患者的临床病理和随访资料进行分析,选择15个可能影响预后的因素进行多因素分析.以淋巴结转移数目(0枚、1枚和≥2枚)的不同,对Ⅱ、Ⅲ期食管癌以新的标准进行TNM分期.结果影响食管癌切除术后患者预后的主要因素为淋巴结转移数目、肿瘤侵及深度、部位、组织类型和肿瘤长度等(P<0.01).肿瘤侵及深度、肿瘤长度和组织分化程度与淋巴结转移呈正相关(P<0.01).0、1和≥2枚转移淋巴结组患者的5年生存率分别为59.1%、32.0%和8.9%(P<0.01).转移淋巴结为1枚和≥2枚的T2N1M0期和T3N1M0期患者的5年生存率分别为43.1%、18.0%(P<0.01)和28.0%、9.6%(P<0.01).新分期中Ⅱ a期、Ⅱb期、Ⅲ a期和Ⅲ b期的5年生存率分别为56.5%、43.9%、25.6%和11.1%(P<0.01).结论影响食管癌切除术后患者预后的主要因素为淋巴结转移,而影响淋巴结转移的主要因素为肿瘤侵及深度、肿瘤长度和组织分化程度.为提高食管癌切除术后患者5年生存率,必须加强区域淋巴结的清扫和针对淋巴结转移的综合治疗.淋巴结转移数目明显影响食管癌患者的预后,以转移淋巴结为0、1和≥2枚进行分级,能够准确地反映淋巴结转移数目与患者预后的关系;根据淋巴结转移数目的不同进行的新分期能更好地反映食管癌切除术患者预后的变化,为国际抗癌联盟食管癌TNM分期标准提供了修订依据.
목적 탐토영향흉단식관암절제술후환자예후적인소,이급림파결전이수목대환자예후화TNM분기표준적영향.방법 대1224례비수술사망적식관암절제술환자적림상병리화수방자료진행분석,선택15개가능영향예후적인소진행다인소분석.이림파결전이수목(0매、1매화≥2매)적불동,대Ⅱ、Ⅲ기식관암이신적표준진행TNM분기.결과 영향식관암절제술후환자예후적주요인소위림파결전이수목、종류침급심도、부위、조직류형화종류장도등(P<0.01).종류침급심도、종류장도화조직분화정도여림파결전이정정상관(P<0.01).0、1화≥2매전이림파결조환자적5년생존솔분별위59.1%、32.0%화8.9%(P<0.01).전이림파결위1매화≥2매적T2N1M0기화T3N1M0기환자적5년생존솔분별위43.1%、18.0%(P<0.01)화28.0%、9.6%(P<0.01).신분기중Ⅱ a기、Ⅱb기、Ⅲ a기화Ⅲ b기적5년생존솔분별위56.5%、43.9%、25.6%화11.1%(P<0.01).결론 영향식관암절제술후환자예후적주요인소위림파결전이,이영향림파결전이적주요인소위종류침급심도、종류장도화조직분화정도.위제고식관암절제술후환자5년생존솔,필수가강구역림파결적청소화침대림파결전이적종합치료.림파결전이수목명현영향식관암환자적예후,이전이림파결위0、1화≥2매진행분급,능구준학지반영림파결전이수목여환자예후적관계;근거림파결전이수목적 불동진행적신분기능경호지반영식관암절제술환자예후적변화,위국제항암련맹식관암TNM분기표준제공료수정의거.
Objective To investigate the prognostic factors and influence of the number of lymph node metastases on survival and UICC-TNM classification in patients with thoracic esophageal cancer after curative resection. Methods From 1985 to 1990, 1224 patients were surgically treated for thoracic esophageal cancer. The patients who died within 30 days after operation were not included in this study. Fifteen factors possibly influencing survival of these patients were selected and analyzed. A multivariate analysis of these individual variables was performed by Cox proportional hazard model. According to the n, mher of lymph node metastases (0, 1 and ≥ 2), a new modification of the TNM classification was suggested: stage Ⅱ a (T2N0M0 and T3N0M0), stage Ⅱb [T1N1M0 and T2N1 (1) M0], stage Ⅲ a [T2N1 (2)M0 and T3N1 (1)M0] and stage Ⅲ b [T3N1 (2)M0 and T4NanyMO]. Results According to multivariate analysis, lymph node metastases, depth of invasion, location of tumor, histological classification and length of the tumor were of prognostic significance (P < 0.01). There was obvious correlation between the rate of lymph node metastasis and the depth of invasion, length of tumor and grade of differentiation. The 5-year survival rate of the patients with 0, 1 and ≥2 positive metastatic lymph nodes was 59.1%, 32.0% and 8.9%, respectively. The 5-year survival rate of the patients with stage T2N1M0 and stage T3N1M0 was significantly higher in those with only one lymph node involved than in those with two or more lymph nodes involved (43.1% vs. 18.0% and 28.0% vs. 9.6%, P<0.01). The 5-year survival rate of the modified stage Ⅱa, Ⅱb, Ⅲa and Ⅲb was56.5%, 43.9%, 25.6% and 11.1%, respectively, with a statistically significant difference among different stages (P < 0. 01). Conclusion The lymph node metastasis is the most important prognostic factor for thoracic esophageal cancer after resection. The major influencing factors of lymph node metastasis are the depth of invasion, length of tumor and grade of differentiation. Therefore, the lymphadenectomy along with esophngectomy and subsequently combined modality therapy against lymph node metastasis is necessary to improve the S-year survival rate. Our proposed new classification based on number of lymph node metastases (0, 1, ≥2 positive nodes) is more applicable because it can well reflect the correlation between lymph node metastasis and the survival, and provides evidence for the modification of the currently used UICC TNM staging system for surgically treated thoracic esophageal cancer.