CAJ | 학술논문

背景与目的：目前肿瘤长度与食管癌的预后关系争议较大，有关淋巴结转移阴性食管癌患者的不同病变长度与其临床病理资料的相关性及其对预后影响的研究报道很少。本研究探讨病变长度对淋巴结阴性食管癌患者的临床病理及预后影响。方法：回顾性分析2008年1月—2011年12月南京医科大学第一附属医院经手术病理证实的686例淋巴结阴性食管癌患者的临床病理资料及生存时间。运用SPSS软件的决策树模型决定截点(cut-off)值。采用单因素和多因素方法分析病变长度对淋巴结阴性食管癌的预后影响。结果：cut-off值3 cm以上，死亡风险明显上升。取3 cm为cut-off值，将淋巴结阴性食管癌分为cut-off值≤3 cm及＞3 cm两组。两组性别、发病年龄、病变位置、病理类型、组织分化的差异均无统计学意义(P＞0.05)，而T分期差异有统计学意义(P＜0.001)，且T分期与病变长度呈正相关(r=0.373)。病变长度≤3 cm的419例患者1、3和5年生存率分别为95.7%、84.4%和76.1%，病变长度＞3 cm的267例患者分别为88.3%、57.8%、46.5%，两组差异有统计学意义(P＜0.001)。分别按照病变长度及T分期进行分组，≤3 cm与T1-2的生存曲线重合较好，而＞3 cm与T3的生存曲线也很相近。单因素和多因素预后生存分析结果显示，病变长度为淋巴结阴性食管癌的独立预后因素(P＜0.001)。结论：食管癌的病变长度与浸润深度关系密切，建议将病变长度纳入T分期，且可将≤3 cm归为T1-2分期，＞3 cm归为T3分期。淋巴结阴性食管癌的病变长度是一个重要的预后因素，可以据此区分食管癌术后的高风险人群。
배경여목적：목전종류장도여식관암적예후관계쟁의교대，유관림파결전이음성식관암환자적불동병변장도여기림상병리자료적상관성급기대예후영향적연구보도흔소。본연구탐토병변장도대림파결음성식관암환자적림상병리급예후영향。방법：회고성분석2008년1월—2011년12월남경의과대학제일부속의원경수술병리증실적686례림파결음성식관암환자적림상병리자료급생존시간。운용SPSS연건적결책수모형결정절점(cut-off)치。채용단인소화다인소방법분석병변장도대림파결음성식관암적예후영향。결과：cut-off치3 cm이상，사망풍험명현상승。취3 cm위cut-off치，장림파결음성식관암분위cut-off치≤3 cm급＞3 cm량조。량조성별、발병년령、병변위치、병리류형、조직분화적차이균무통계학의의(P＞0.05)，이T분기차이유통계학의의(P＜0.001)，차T분기여병변장도정정상관(r=0.373)。병변장도≤3 cm적419례환자1、3화5년생존솔분별위95.7%、84.4%화76.1%，병변장도＞3 cm적267례환자분별위88.3%、57.8%、46.5%，량조차이유통계학의의(P＜0.001)。분별안조병변장도급T분기진행분조，≤3 cm여T1-2적생존곡선중합교호，이＞3 cm여T3적생존곡선야흔상근。단인소화다인소예후생존분석결과현시，병변장도위림파결음성식관암적독립예후인소(P＜0.001)。결론：식관암적병변장도여침윤심도관계밀절，건의장병변장도납입T분기，차가장≤3 cm귀위T1-2분기，＞3 cm귀위T3분기。림파결음성식관암적병변장도시일개중요적예후인소，가이거차구분식관암술후적고풍험인군。
Background and purpose:At present, the relationship between tumor length and prognosis of esophageal carcinoma patients has been a controversial topic, and there have been few studies describing the effect of tumor length on clinicopathology and prognosis of node-negative esophageal carcinoma patients. The purpose of this study was to investigate the effect of the tumor length on clinicopathology and prognosis of node-negative esophageal carcinoma patients.Methods:The clinicopathological characteristics and survival time of 686 node-negative esophageal carcinoma patients, conifrmed by surgical pathology specimens in the First Afifliated Hospital of Nanjing Medical University from Jan. 2008 to Dec. 2010, were retrospectively analyzed. The optimal cut-off value was determined by decision tree model. Univariate and multivariate methods were used to analyze the prognostic factors of node-negative esophageal carcinoma patients.Results:In decision tree analysis, esophageal tumor length was correlated with an increasing hazard ratio for death with a cut-off value at 3 cm. No signiifcant differences were found in gender, onset age, lesion site and pathological type between 2 groups which were patients with tumor length≤3 cm and tumor length >3 cm (P>0.05). The only 1 difference between 2 groups was T stage (P<0.001), and tumor length had a positive correlation with T stage (r=0.373). The 1-, 3- and 5-year survival rates of patients with tumor length≤3 cm and tumor length >3 cm were 95.7%, 84.4%, 76.1% and 88.3%, 57.8%, 46.5% respectively, and the difference was statistically signiifcant (P<0.001). Tumor length was signiifcantly associated with overall survival in univariate and multivariate analyses.Conclusion:Tumor length has close relationship with T stage in node-negative esophageal carcinoma patients. Tumor length≤3 cm could be considered as T1-2 and >3 cm as T3. Tumor length is an important prognostic factor for esophageal carcinoma patients without lymphatic metastasis.