本文選題：食管腫瘤/pN0期 + 分期/pT1-3N0M0�。� 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：第一部分pN0期食管癌術(shù)后的預(yù)后因素目的:探討pN0期食管癌術(shù)后的預(yù)后相關(guān)因素及術(shù)后輔助治療價值。方法:收集2008年1月至2012年12月行食管癌切除術(shù)、術(shù)后病理pN0期、術(shù)后生存期≥1月的1250例胸段食管癌患者資料。其中男性828例,女性422例;中位年齡61歲,范圍在31歲~86歲之間。311例術(shù)前CT有直徑1cm縱隔小淋巴結(jié);采用兩野手術(shù)者1214例,三野手術(shù)者36例;腫瘤位于胸上段167例、胸中段863例、胸下段220例;食管腫瘤中位長度5cm(范圍0.2~14cm);術(shù)中粘連程度:無粘連者120例、輕度粘連者563例、重度粘連者415例、粘連程度記錄不詳者152例;吻合口位置:頸部157例、胸膜頂62例、主動脈弓上907例、主動脈弓下124例;術(shù)中清掃淋巴結(jié)中位數(shù)9枚(范圍0~35枚);術(shù)后病理類型:中高分化鱗癌1042例,低分化鱗癌121例,非鱗癌87例;術(shù)后病理T分期:pT1期185例、pT2期276例、pT3期755例、pT4期34例。13例行術(shù)前化療;單純手術(shù)者588例,622例接受術(shù)后輔助性治療,其中輔助性放療49例、化療547例、放化療66例。采用SPSS 21.0統(tǒng)計學(xué)軟件進行統(tǒng)計分析。結(jié)果:隨訪截止日期為2016年12月1日;全組患者失訪17例,隨訪率為98.64%。有450例出現(xiàn)腫瘤進展,其中局部區(qū)域性復(fù)發(fā)占23.0%(287/1250)、遠處轉(zhuǎn)移占8.2%(102/1250)、局部區(qū)域性復(fù)發(fā)合并遠處轉(zhuǎn)移占4.9%(61/1250)。全組術(shù)后1、3、5年總生存率(OS)分別為92.7%、72.6%、62.1%;單因素分析,性別、年齡、腫瘤位置、縱隔小淋巴結(jié)、手術(shù)方式、術(shù)中粘連程度、清掃淋巴結(jié)數(shù)目、術(shù)后病理類型、殘端陽性與否、脈管瘤栓、pT分期、術(shù)后輔助治療均與pN0期食管癌術(shù)后OS有關(guān)(P0.05);多因素分析,性別、年齡、腫瘤位置、縱隔小淋巴結(jié)、術(shù)中粘連程度、清掃淋巴結(jié)數(shù)目、術(shù)后病理類型、pT分期、術(shù)后輔助治療是影響pN0期食管癌術(shù)后OS的獨立因素。全組術(shù)后1、3、5年無進展生存率(PFS)分別為83.8%、63.9%和56.9%;單因素分析顯示,性別、年齡、縱隔小淋巴結(jié)、腫瘤位置、手術(shù)方式、術(shù)中粘連程度、清掃淋巴結(jié)數(shù)目、術(shù)后病理類型、殘端陽性與否、脈管瘤栓、pT分期、術(shù)后輔助治療與PFS相關(guān)(P0.05);多因素分析顯示,年齡、腫瘤位置、縱隔小淋巴結(jié)、術(shù)中粘連程度、清掃淋巴結(jié)數(shù)目、術(shù)后病理類型、pT分期、術(shù)后輔助治療是影響pN0期食管癌術(shù)后PFS的獨立危險因素。單純手術(shù)者1、3、5年OS分別為89.5%、69.7%、59.1%,術(shù)后放療者1、3、5年OS分別為83.7%、59.2%、39.6%,術(shù)后化療者1、3、5年OS分別94.3%、76.6%、68.4%;單純手術(shù)、術(shù)后放療、術(shù)后化療者1、3、5年P(guān)FS分別80.9%、62.2%、55.2%,71.4%、44.9%、34.3%,87.8%、68.7%、62.5%。術(shù)后化療與單純手術(shù)比較能提高OS和PFS(P0.05),而術(shù)后放療OS和PFS明顯低于單純手術(shù)(P0.05);但術(shù)后放療組與單純手術(shù)組比較pT分期晚、術(shù)中重度粘連者比例高(P0.05)。結(jié)論:pN0期胸段食管癌術(shù)后,女性、年齡輕、胸中下段癌、術(shù)前CT縱隔無小淋巴結(jié)、清掃淋巴結(jié)數(shù)目較多、術(shù)中粘連程度較輕、pT分期早、中高分化鱗癌、術(shù)后輔助化療者預(yù)后較好,而男性、年齡較大、胸上段癌、術(shù)前CT縱隔有小淋巴結(jié)、清掃淋巴結(jié)數(shù)目較少、術(shù)中粘連程度較重、pT分期晚、低分化鱗癌或非鱗癌、單純手術(shù)者預(yù)后較差;術(shù)后放療的作用有待證實。第二部分pT1-3N0M0期胸段食管鱗癌根治術(shù)后復(fù)發(fā)規(guī)律目的:回顧性分析pT1-3N0M0期胸段食管鱗癌兩野根治術(shù)后的復(fù)發(fā)規(guī)律。方法:收集2008年1月至2012年12月行食管癌根治性切除術(shù)(R0)、術(shù)后病理pT1-3N0M0期、術(shù)后生存期≥3個月的488例胸段食管鱗癌患者資料。其中男性303例,女性185例;年齡34~86歲,中位年齡62歲。腫瘤位于胸上段61例、胸中段344例、胸下段83例;pT分期:pT1期102例,pT2期126例,pT3期260例。采用SPSS 21.0統(tǒng)計學(xué)軟件進行統(tǒng)計分析。結(jié)果:隨訪截止日期為2016年12月1日。pT1-3N0M0期胸段食管鱗癌根治術(shù)后的總復(fù)發(fā)率為36.9%(180/488),局部區(qū)域復(fù)發(fā)率為21.5%(105/488)、遠處轉(zhuǎn)移率為6.8%(33/488)、局部區(qū)域復(fù)發(fā)合并遠處轉(zhuǎn)移率為8.6%(42/488);卡方檢驗結(jié)果顯示,腫瘤位置、清掃淋巴結(jié)數(shù)目、術(shù)前CT縱隔小淋巴結(jié)和pT分期與pT1-3N0M0期胸段食管鱗癌根治術(shù)后的總復(fù)發(fā)有關(guān)(P0.05);Logistic多因素分析顯示,腫瘤位置、清掃淋巴結(jié)數(shù)目、術(shù)前CT縱隔小淋巴結(jié)和pT分期是影響術(shù)后總復(fù)發(fā)的獨立危險因素。pT1-3N0M0期胸段食管鱗癌根治術(shù)后的總局部區(qū)域復(fù)發(fā)率為30.1%(147/488),頸部、縱隔、腹腔復(fù)發(fā)分別占總局部區(qū)域復(fù)發(fā)的21.1%(31/147)、80.3%(118/147)、7.5%(11/147);卡方檢驗結(jié)果顯示,腫瘤位置、術(shù)前CT縱隔小淋巴結(jié)、pT分期與pT1-3N0M0期胸段食管鱗癌根治術(shù)后的局部區(qū)域復(fù)發(fā)有關(guān)(P0.05);Logistic多因素分析顯示,腫瘤位置、清掃淋巴結(jié)數(shù)目、pT分期是影響術(shù)后局部區(qū)域復(fù)發(fā)的獨立危險因素。結(jié)論:pT1-3N0M0期胸段食管鱗癌根治術(shù)后復(fù)發(fā)率較高,主要為局部區(qū)域復(fù)發(fā),且以縱隔復(fù)發(fā)最常見;腫瘤位置、清掃淋巴結(jié)數(shù)目、pT分期為影響術(shù)后總復(fù)發(fā)和局部區(qū)域復(fù)發(fā)的獨立危險因素;胸上段鱗癌、清掃淋巴結(jié)少和pT分期晚者術(shù)后復(fù)發(fā)率高;術(shù)前縱隔有小淋巴結(jié)者,術(shù)后復(fù)發(fā)率增加。
[Abstract]:The first part of the prognosis of esophageal carcinoma after pN0 Objective: To investigate the prognostic factors and the value of postoperative adjuvant therapy for the postoperative esophagus cancer in pN0. Methods: 1250 cases of thoracic esophageal cancer were collected from January 2008 to December 2012, the postoperative pathological pN0 period, and the postoperative survival time of the thoracic esophagus cancer patients, including 828 males and 422 females. Case: middle age 61 years old,.311 was 31 years old between ~86 years and CT had small diameter 1cm mediastinal lymph nodes; 1214 cases with two field operations, 36 cases with Sanye operation, 167 cases in the upper thoracic segment, 863 in the chest, 220 in the lower thoracic segment, and 5cm in the middle of the esophagus (0.2~14cm); the degree of adhesion in the operation: 120 cases without adhesions and mild adhesion. There were 563 cases, 415 cases of severe adhesion and 152 cases of unknown adhesion, 157 cases in the neck, 62 cases in the pleural top, 907 in the aortic arch, 124 in the aortic arch, 9 in the median of the lymph nodes in the operation (range 0~35), and the postoperative pathological type: moderately high differentiated squamous carcinoma, 121 cases of low differentiated squamous cell carcinoma and 87 cases of non squamous cell carcinoma; postoperative pathological T Staging: 185 cases of pT1, 276 cases in pT2, 755 cases in pT3 stage, 34 cases of.13 routine chemotherapy in pT4 period, 588 cases of simple operation, 622 cases receiving postoperative adjuvant therapy, including 49 cases of adjuvant radiotherapy, 547 cases of chemotherapy and 66 cases of radiotherapy and chemotherapy. Results: the follow-up date was December 1, 2016; the whole group was lost in December 1, 2016. In 17 cases, 17 cases were followed up with 450 cases of tumor progression, of which local regional recurrence accounted for 23% (287/1250), distant metastasis accounted for 8.2% (102/1250), local regional recurrence and distant metastasis accounted for 4.9% (61/1250). The total 1,3,5 year survival rate (OS) in the whole group was 92.7%, 72.6%, 62.1%, respectively, and single factor analysis, sex, age, tumor location, longitudinal Small lymph nodes, surgical methods, intraoperative adhesion, number of lymph nodes, postoperative pathological type, stump positive or not, vascular tumor thrombus, pT staging, postoperative adjuvant therapy were related to OS (P0.05) after the operation of pN0 esophageal carcinoma; multiple factor analysis, sex, age, tumor location, small mediastinal lymph nodes, intraoperative adhesion, lymph node number, and the number of lymph nodes cleaned, and the number of lymph nodes cleaned Post pathological type, pT staging and postoperative adjuvant therapy were independent factors affecting OS after pN0 esophageal carcinoma operation. The 1,3,5 year free survival rate (PFS) in the whole group was 83.8%, 63.9% and 56.9%, respectively. The single factor analysis showed that sex, age, small mediastinal lymph nodes, tumor location, operation mode, degree of adhesion, number of lymph nodes, postoperative pathology Type, stump positive or not, vascular tumor thrombus, pT staging and postoperative adjuvant therapy with PFS (P0.05); multivariate analysis showed that age, tumor location, small mediastinal lymph nodes, intraoperative adhesion, number of lymph nodes, postoperative pathological type, pT staging, postoperative adjuvant therapy were independent risk factors for PFS after pN0 esophagus carcinoma. Simple hand The 1,3,5 year OS of the operator was 89.5%, 69.7%, 59.1% respectively. The OS of postoperative radiotherapy was 83.7%, 59.2%, 39.6% respectively. The postoperative chemotherapy recipients were 94.3%, 76.6%, 68.4% respectively, 1,3,5 year OS, respectively, and postoperative radiotherapy and postoperative chemotherapy 1,3,5 PFS 80.9%, 62.2%, 55.2%, 71.4%, 44.9%, etc. S and PFS (P0.05), and postoperative radiotherapy OS and PFS were significantly lower than that of the simple operation (P0.05), but the postoperative radiotherapy group was later than the simple operation group, and the proportion of the patients with severe adhesion was higher (P0.05). Conclusion: after the operation of stage pN0 stage thoracic esophagus cancer, women, age light, middle and lower thoracic carcinoma, no small lymph nodes in the CT mediastinum before operation, the number of lymph nodes clear, and intraoperative mucus. PT staging early, medium and high differentiated squamous cell carcinoma with better prognosis, and the prognosis was better in the patients with adjuvant chemotherapy, while male, older, upper thoracic carcinoma, small lymph nodes in CT mediastinum, less lymph node number, heavy adhesion in the operation, late pT stage, low differentiated squamous cell carcinoma or non squamous cell carcinoma, and poor prognosis; the effect of postoperative radiotherapy is still to be proved. Second part of the recurrence rule after radical resection of thoracic esophageal squamous cell carcinoma in phase pT1-3N0M0: retrospective analysis of the recurrence rules after two field radical resection of thoracic esophageal squamous cell carcinoma. Methods: to collect radical resection of esophageal carcinoma (R0) from January 2008 to December 2012, pT1-3N0M0 stage of postoperative pathology, and 488 thoracic segment food for 3 months after operation. Data of patients with squamous cell carcinoma, including 303 males and 185 females; age 34~86 years, middle age 62 years old. Tumors located in the upper thoracic segment, 61 in the upper thoracic segment, 344 in the thoracic segment, 83 in the lower thoracic segment, 102 in pT1 stage in pT stage, 126 in pT3 stage, 260 in pT3 phase. Results: the follow-up deadline was the.PT1-3N0M0 phase of December 1, 2016. The total recurrence rate after radical resection of thoracic esophageal squamous cell carcinoma was 36.9% (180/488), the local regional recurrence rate was 21.5% (105/488), the distant metastasis rate was 6.8% (33/488), the local regional recurrence combined with the distant metastasis rate was 8.6% (42/488). The chi square test showed that the tumor location, the number of lymph nodes, the CT mediastinal small lymph nodes and the pT staging and pT1-3N0M0 before the operation. The total recurrence after radical resection of thoracic esophageal squamous cell carcinoma (P0.05); Logistic multivariate analysis showed that the tumor location, the number of lymph nodes, the CT mediastinal small lymph nodes and the pT staging were the independent risk factors for the postoperative total recurrence of the thoracic esophagus, the total local recurrence rate was 30.1% (147/488) after radical resection of the thoracic esophagus squamous carcinoma. 21.1% (31/147), 80.3% (118/147), 7.5% (11/147) recurrences of the mediastinum and abdominal cavity respectively. The chi square test showed that the tumor location, the small lymph node of the CT mediastinum, pT staging with the local regional recurrence after the radical resection of the thoracic esophageal squamous cell carcinoma (P0.05); Logistic multiple factor analysis showed the tumor location, the location of the tumor, clear The number of lymph nodes, pT staging is an independent risk factor affecting local regional recurrence after operation. Conclusion: the recurrence rate of thoracic esophageal squamous cell carcinoma in pT1-3N0M0 stage is higher, mainly local regional recurrence, and the most common mediastinal recurrence; tumor location, the number of lymph nodes clear, pT staging as a result of the total recurrence of postoperative and local regional recurrence alone. The recurrence rate was higher in patients with upper thoracic squamous cell carcinoma, less lymph node clearance and pT staging.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.1

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