目的 探讨影响进展期食管胃结合部腺癌根治性切除术后复发转移的危险因素.方法 回顾性分析2000年1月至2007年1月天津医科大学附属肿瘤医院行根治性切除术的385例食管胃结合部腺癌患者的临床资料.其中228例患者术后无复发转移(无复发转移组),157例患者出现复发转移(复发转移组).通过门诊或电话方式进行随访,了解患者生存情况,随访时间截至2012年9月.单因素及多因素分析探讨可能影响患者术后发生复发转移的危险因素.术后复发转移的单因素分析采用x2检验,再将单因素分析中有统计学意义的变量纳入Logistic回归模型进行多因素分析；采用Kaplan-Meier法绘制生存曲线,生存分析采用Log-rank检验.结果 术后随访时间为3～ 108个月,中位随访时间为36个月.全组患者术后157例发生肿瘤复发转移,肿瘤平均复发时间为根治性切除术后17.9个月.单因素分析结果显示:大体分型、分化类型、浸润深度、阳性淋巴结数目、阴性淋巴结数目及TNM分期有统计学意义(x2=5.248,13.493,12.319,18.315,9.704,10.281,P＜0.05).多因素分析结果显示:分化类型、浸润深度、阳性淋巴结数目及阴性淋巴结数目是食管胃结合部腺癌根治性切除术后复发转移的独立危险因素(OR=1.805,1.809,1.520,0.763,P＜0.05).无复发转移组和复发转移组患者的阳性淋巴结数目分别为(3.86±0.28)枚和(6.89±0.58)枚,两组比较,差异有统计学意义(t=5.118,P＜0.05)；无复发转移组和复发转移组患者的阴性淋巴结数目分别为(14.04±0.54)枚和(10.53±0.56)枚,两组比较,差异有统计学意义(t=4.386,P＜0.05).阳性淋巴结数目为0、1～2、3～6、≥7枚的患者5年生存率分别为46.4％、43.8％、27.1％、7.2％,中位生存时间分别为53、47、35、26个月,不同阳性淋巴结数目患者5年生存率比较,差异有统计学意义(x2=54.783,P＜0.05)；阴性淋巴结数目为＜9、10 ～15、≥16枚的患者5年生存率分别为22.1％、21.5％、45.5％,中位生存时间分别为28、34、47个月,不同阴性淋巴结数目患者5年生存率比较,差异有统计学意义(x2=22.814,P＜0.05).结论 肿瘤的分化类型、浸润深度、阳性和阴性淋巴结数目是食管胃结合部腺癌根治性切除术后复发转移的独立危险因素,其中阳性和阴性淋巴结数目对患者预后的影响具有重要意义.
目的 探討影響進展期食管胃結閤部腺癌根治性切除術後複髮轉移的危險因素.方法 迴顧性分析2000年1月至2007年1月天津醫科大學附屬腫瘤醫院行根治性切除術的385例食管胃結閤部腺癌患者的臨床資料.其中228例患者術後無複髮轉移(無複髮轉移組),157例患者齣現複髮轉移(複髮轉移組).通過門診或電話方式進行隨訪,瞭解患者生存情況,隨訪時間截至2012年9月.單因素及多因素分析探討可能影響患者術後髮生複髮轉移的危險因素.術後複髮轉移的單因素分析採用x2檢驗,再將單因素分析中有統計學意義的變量納入Logistic迴歸模型進行多因素分析；採用Kaplan-Meier法繪製生存麯線,生存分析採用Log-rank檢驗.結果 術後隨訪時間為3～ 108箇月,中位隨訪時間為36箇月.全組患者術後157例髮生腫瘤複髮轉移,腫瘤平均複髮時間為根治性切除術後17.9箇月.單因素分析結果顯示:大體分型、分化類型、浸潤深度、暘性淋巴結數目、陰性淋巴結數目及TNM分期有統計學意義(x2=5.248,13.493,12.319,18.315,9.704,10.281,P＜0.05).多因素分析結果顯示:分化類型、浸潤深度、暘性淋巴結數目及陰性淋巴結數目是食管胃結閤部腺癌根治性切除術後複髮轉移的獨立危險因素(OR=1.805,1.809,1.520,0.763,P＜0.05).無複髮轉移組和複髮轉移組患者的暘性淋巴結數目分彆為(3.86±0.28)枚和(6.89±0.58)枚,兩組比較,差異有統計學意義(t=5.118,P＜0.05)；無複髮轉移組和複髮轉移組患者的陰性淋巴結數目分彆為(14.04±0.54)枚和(10.53±0.56)枚,兩組比較,差異有統計學意義(t=4.386,P＜0.05).暘性淋巴結數目為0、1～2、3～6、≥7枚的患者5年生存率分彆為46.4％、43.8％、27.1％、7.2％,中位生存時間分彆為53、47、35、26箇月,不同暘性淋巴結數目患者5年生存率比較,差異有統計學意義(x2=54.783,P＜0.05)；陰性淋巴結數目為＜9、10 ～15、≥16枚的患者5年生存率分彆為22.1％、21.5％、45.5％,中位生存時間分彆為28、34、47箇月,不同陰性淋巴結數目患者5年生存率比較,差異有統計學意義(x2=22.814,P＜0.05).結論 腫瘤的分化類型、浸潤深度、暘性和陰性淋巴結數目是食管胃結閤部腺癌根治性切除術後複髮轉移的獨立危險因素,其中暘性和陰性淋巴結數目對患者預後的影響具有重要意義.
목적 탐토영향진전기식관위결합부선암근치성절제술후복발전이적위험인소.방법 회고성분석2000년1월지2007년1월천진의과대학부속종류의원행근치성절제술적385례식관위결합부선암환자적림상자료.기중228례환자술후무복발전이(무복발전이조),157례환자출현복발전이(복발전이조).통과문진혹전화방식진행수방,료해환자생존정황,수방시간절지2012년9월.단인소급다인소분석탐토가능영향환자술후발생복발전이적위험인소.술후복발전이적단인소분석채용x2검험,재장단인소분석중유통계학의의적변량납입Logistic회귀모형진행다인소분석；채용Kaplan-Meier법회제생존곡선,생존분석채용Log-rank검험.결과 술후수방시간위3～ 108개월,중위수방시간위36개월.전조환자술후157례발생종류복발전이,종류평균복발시간위근치성절제술후17.9개월.단인소분석결과현시:대체분형、분화류형、침윤심도、양성림파결수목、음성림파결수목급TNM분기유통계학의의(x2=5.248,13.493,12.319,18.315,9.704,10.281,P＜0.05).다인소분석결과현시:분화류형、침윤심도、양성림파결수목급음성림파결수목시식관위결합부선암근치성절제술후복발전이적독립위험인소(OR=1.805,1.809,1.520,0.763,P＜0.05).무복발전이조화복발전이조환자적양성림파결수목분별위(3.86±0.28)매화(6.89±0.58)매,량조비교,차이유통계학의의(t=5.118,P＜0.05)；무복발전이조화복발전이조환자적음성림파결수목분별위(14.04±0.54)매화(10.53±0.56)매,량조비교,차이유통계학의의(t=4.386,P＜0.05).양성림파결수목위0、1～2、3～6、≥7매적환자5년생존솔분별위46.4％、43.8％、27.1％、7.2％,중위생존시간분별위53、47、35、26개월,불동양성림파결수목환자5년생존솔비교,차이유통계학의의(x2=54.783,P＜0.05)；음성림파결수목위＜9、10 ～15、≥16매적환자5년생존솔분별위22.1％、21.5％、45.5％,중위생존시간분별위28、34、47개월,불동음성림파결수목환자5년생존솔비교,차이유통계학의의(x2=22.814,P＜0.05).결론 종류적분화류형、침윤심도、양성화음성림파결수목시식관위결합부선암근치성절제술후복발전이적독립위험인소,기중양성화음성림파결수목대환자예후적영향구유중요의의.
Objective To investigate the correlation between different clinicopathological factors and the recurrence and metastasis of advanced adenocarcinoma of the esophagogastric junction after curative resection,and to analyze the effects of the factors on the prognosis of these patients.Methods The clinical data of 385 patients with advanced adenocarcinoma of the esophagogastric junction who received curative resection at the Affiliated Hospital of Tianjin Medical University from January 2000 to January 2007 were retrospectively analyzed.There were 228 patients did not have tumor recurrence and metastasis (non-recurrence and metastasis group) and 157 patients had tumor recurrence and metastasis (recurrence and metastasis group).Risk factors which might influence postoperative recurrence and metastasis were analyzed using univariate analysis (chi-square test) and multivariate analysis (Logistic regression model).All patients were followed up via out-patient examination or phone call.The survival curve was drawn by Kaplan-Meier method,and the survival analysis was done by Log-rank test.Results The median time for follow-up was 36 months (range,3-108 months).A total of 157 patients had postoperative tumor recurrence and metastasis,and the mean time of tumor recurrence was 17.9 mouths.The results of univariate analysis showed that tumor type,differentiation degree,invasion depth,number of positive and negative lymph nodes,TNM staging were risk factors for the postoperative recurrence and metastasis of adenocarcinoma of the esophagogastric junction after curative resection (x2=5.248,13.493,12.319,18.315,9.704,10.281,P ＜ 0.05).The results of multivariate analysis showed that differentiation degree,invasion depth,number of positive and negative lymph nodes were the independent risk factors influencing the recurrence and metastasis of adenocarcinoma of the esophagogastric junction after curative resection (OR =1.805,1.809,1.520,0.763,P ＜0.05).The numbers of positive lymph nodes in the non-recurrence and metastasis group and the recurrence and metastasis group were 3.86 ± 0.28 and 6.89 ± 0.58,with a significant difference (t =5.118,P ＜ 0.05).The number of negative lymph nodes in the non-recurrence and metastasis group and the recurrence and metastasis group were 14.04 ±0.54 and 10.53 ±0.56,with a significant difference between the 2 groups (t =4.386,P ＜0.05).The 5-year survival rates of patients with the numbers of positive lymph nodes of 0,1-2,3-6 and more than 7 were 46.4％,43.8％,27.1％ and 7.2％,respectively,and the corresponding median survival time were 53,47,35 and 26 months.There was a significant difference in the 5-year survival rate among patients with different numbers of positive lymph nodes (x2 =54.783,P ＜ 0.05).The 5-year survival rates of patients with the number of negative lymph nodes under 9,between 10 and 15 and more than 16 were 22.1％,21.5％ and 45.5％,respectively,and the corresponding median survival time were 28,34,47 months.There was a significant difference in the 5-year survival rate among patients with different numbers of negative lymph nodes (x2=22.814,P ＜ 0.05).Conclusions Tumor type,invasion depth,number of positive and negative lymph nodes are independent risk factors of postoperative recurrence and metastasis of adenocarcinoma of the esophagogastric junction,and the number of positive and negative lymph nodes are important for the prognosis of patients with adenocarcinoma of the esophagogastric junction.
