CAJ | 학술논문

目的通过比较中晚期食管癌四种大体类型的生物学特征，探讨食管癌大体类型对患者生存期的影响，加深对食管癌关键预后影响因素的了解。方法采用入户/电话进行问卷调查及生存随访，医院核查食管癌患者信息，采用卡方检验、Kaplan-Meier生存曲线，Log-Rank检验和Cox生存分析模型，分析中晚期食管癌肿瘤大体类型特征及其对患者生存期的影响。结果成功随访9672例患者（929．％）。蕈伞型患者生存期明显优于髓质型、溃疡型和缩窄型患者（ P＜00．5）。中晚期食管癌四种大体类型在高低发区、性别、青年（≤50岁）和中老年（＞50岁）患者中的构成比明显不同（P ＜00．5）。在肿瘤部位（上、中和下段）、分化程度、阳性淋巴结转移个数和浸润程度上四种大体类型的构成亦明显不同（P ＜00．5），值得指出的是，蕈伞型高分化所占比例高于其他三型，阳性转移淋巴结两个以上的患者少于其他三型，T3＋ T4级患者所占比例明显底于其他三型。COX多因素分析肿瘤大体类型不是影响中晚期食管癌患者生存期的独立因素。结论蕈伞型高分化癌的比例高于髓质型、溃疡型和缩窄型患者，而在阳性转移淋巴结两个以上和T3＋ T4级患者所占比例低于以上三型，生存期最优；中晚期食管癌大体类型不是影响患者生存期的独立因素。
목적통과비교중만기식관암사충대체류형적생물학특정，탐토식관암대체류형대환자생존기적영향，가심대식관암관건예후영향인소적료해。방법채용입호/전화진행문권조사급생존수방，의원핵사식관암환자신식，채용잡방검험、Kaplan-Meier생존곡선，Log-Rank검험화Cox생존분석모형，분석중만기식관암종류대체류형특정급기대환자생존기적영향。결과성공수방9672례환자（929．％）。심산형환자생존기명현우우수질형、궤양형화축착형환자（ P＜00．5）。중만기식관암사충대체류형재고저발구、성별、청년（≤50세）화중노년（＞50세）환자중적구성비명현불동（P ＜00．5）。재종류부위（상、중화하단）、분화정도、양성림파결전이개수화침윤정도상사충대체류형적구성역명현불동（P ＜00．5），치득지출적시，심산형고분화소점비례고우기타삼형，양성전이림파결량개이상적환자소우기타삼형，T3＋ T4급환자소점비례명현저우기타삼형。COX다인소분석종류대체류형불시영향중만기식관암환자생존기적독립인소。결론심산형고분화암적비례고우수질형、궤양형화축착형환자，이재양성전이림파결량개이상화T3＋ T4급환자소점비례저우이상삼형，생존기최우；중만기식관암대체류형불시영향환자생존기적독립인소。
Objective The present study aimed to compare the gross biological characteristics of tumor from patients of the four kinds of esophageal cancer at middle and advanced stage and the influence on the survival in order to further shed light on the key prognostic factors for EC . Methods The questionnaire , home interview and/or telephone interview were performed for survival follow-up on ESCC patients , and check the clinical information of ESCC patients in hospitals . The Chi square test , Kaplan-Meier survival analysis , Log-rank test and multivariate Cox regression model were applied to the comparison . Results The followup was successfully made in 9672 cases (92 .9% ) . The survival time in patients of fungating type was significantly longer than that in patients with medullary , ulcerating , and constriction types (P<0 .005 ) . The constituent ratio for four kinds of gross tumor types at middle and advanced stages was significantly different respectively in high and low incidence areas , male and female gender , youth ( ≤50) and older ( > 50) patients (P<0 .05 ) .The constituent ratio for four kinds of gross tumor types at middle and advanced stages was significantly different respectively in tumor location ( upper , middle and lower segment) , tumor differentiation , number of positive lymph nodes , and tumor invasion (P<0 .05 ) . It was noteworthy that the ratio of fungating type patients with well differentiation was higher than that of other three types , but the ratio with two or more positive lymph nodes and at T 3 + T4-stage was less than those of the other three types . Multivariate regression analysis showed that , tumor gross types was not independent factors for survival of patients with EC at middle and advanced stage . Conclusion The ratio of fungating type patients with well differentiation was higher than that of other three types , but , the ratio with two or more positive lymph nodes and at T3 + T4 stage was less than those of the other three types . The survival of fungating type patients was the best . Tumor gross type was not independent factors for survival of patients with advanced EC .