發(fā)布時間：2018-06-09 13:22

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

【摘要】：第一部分pN0期食管癌術后的預后因素目的:探討pN0期食管癌術后的預后相關因素及術后輔助治療價值。方法:收集2008年1月至2012年12月行食管癌切除術、術后病理pN0期、術后生存期≥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例術前CT有直徑1cm縱隔小淋巴結;采用兩野手術者1214例,三野手術者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;術中清掃淋巴結中位數(shù)9枚(范圍0~35枚);術后病理類型: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例行術前化療;單純手術者588例,622例接受術后輔助性治療,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)計學軟件進行統(tǒng)計分析。結果: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)域性復發(fā)占23.0%(287/1250)、遠處轉移占8.2%(102/1250)、局部區(qū)域性復發(fā)合并遠處轉移占4.9%(61/1250)。全組術后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、手術方式、術中粘連程度、清掃淋巴結數(shù)目、術后病理類型、殘端陽性與否、脈管瘤栓、pT分期、術后輔助治療均與pN0期食管癌術后OS有關(P0.05);多因素分析,性別、年齡、腫瘤位置、縱隔小淋巴結、術中粘連程度、清掃淋巴結數(shù)目、術后病理類型、pT分期、術后輔助治療是影響pN0期食管癌術后OS的獨立因素。全組術后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、腫瘤位置、手術方式、術中粘連程度、清掃淋巴結數(shù)目、術后病理類型、殘端陽性與否、脈管瘤栓、pT分期、術后輔助治療與PFS相關(P0.05);多因素分析顯示,年齡、腫瘤位置、縱隔小淋巴結、術中粘連程度、清掃淋巴結數(shù)目、術后病理類型、pT分期、術后輔助治療是影響pN0期食管癌術后PFS的獨立危險因素。單純手術者1、3、5年OS分別為89.5%、69.7%、59.1%,術后放療者1、3、5年OS分別為83.7%、59.2%、39.6%,術后化療者1、3、5年OS分別94.3%、76.6%、68.4%;單純手術、術后放療、術后化療者1、3、5年PFS分別80.9%、62.2%、55.2%,71.4%、44.9%、34.3%,87.8%、68.7%、62.5%。術后化療與單純手術比較能提高OS和PFS(P0.05),而術后放療OS和PFS明顯低于單純手術(P0.05);但術后放療組與單純手術組比較pT分期晚、術中重度粘連者比例高(P0.05)。結論:pN0期胸段食管癌術后,女性、年齡輕、胸中下段癌、術前CT縱隔無小淋巴結、清掃淋巴結數(shù)目較多、術中粘連程度較輕、pT分期早、中高分化鱗癌、術后輔助化療者預后較好,而男性、年齡較大、胸上段癌、術前CT縱隔有小淋巴結、清掃淋巴結數(shù)目較少、術中粘連程度較重、pT分期晚、低分化鱗癌或非鱗癌、單純手術者預后較差;術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后復發(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后的復發(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(R0)、術后病理pT1-3N0M0期、術后生存期≥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)計學軟件進行統(tǒng)計分析。結果: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后的總復發(fā)率為36.9%(180/488),局部區(qū)域復發(fā)率為21.5%(105/488)、遠處轉移率為6.8%(33/488)、局部區(qū)域復發(fā)合并遠處轉移率為8.6%(42/488);卡方檢驗結果顯示,腫瘤位置、清掃淋巴結數(shù)目、術前CT縱隔小淋巴結和pT分期與pT1-3N0M0期胸段食管鱗癌根治術后的總復發(fā)有關(P0.05);Logistic多因素分析顯示,腫瘤位置、清掃淋巴結數(shù)目、術前CT縱隔小淋巴結和pT分期是影響術后總復發(fā)的獨立危險因素。pT1-3N0M0期胸段食管鱗癌根治術后的總局部區(qū)域復發(fā)率為30.1%(147/488),頸部、縱隔、腹腔復發(fā)分別占總局部區(qū)域復發(fā)的21.1%(31/147)、80.3%(118/147)、7.5%(11/147);卡方檢驗結果顯示,腫瘤位置、術前CT縱隔小淋巴結、pT分期與pT1-3N0M0期胸段食管鱗癌根治術后的局部區(qū)域復發(fā)有關(P0.05);Logistic多因素分析顯示,腫瘤位置、清掃淋巴結數(shù)目、pT分期是影響術后局部區(qū)域復發(fā)的獨立危險因素。結論:pT1-3N0M0期胸段食管鱗癌根治術后復發(fā)率較高,主要為局部區(qū)域復發(fā),且以縱隔復發(fā)最常見;腫瘤位置、清掃淋巴結數(shù)目、pT分期為影響術后總復發(fā)和局部區(qū)域復發(fā)的獨立危險因素;胸上段鱗癌、清掃淋巴結少和pT分期晚者術后復發(fā)率高;術前縱隔有小淋巴結者,術后復發(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.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.1

【參考文獻】

相關期刊論文 前10條

1 鄧文英;魏辰;李寧;張燕平;申威;張弛;羅素霞;;食管癌根治術后患者淋巴結轉移與預后的關系[J];中華醫(yī)學雜志;2016年47期

2 江振強;尹海軍;許發(fā)珍;鄔藝忠;彭勇;彭曉婕;;胸腔鏡下食管癌根治術的療效及預后影響因素分析[J];疑難病雜志;2016年11期

3 王玉祥;王麗麗;楊瓊;李靜;齊戰(zhàn);何明;姚繼方;喬學英;;pT3N0M0期胸段食管鱗癌根治術后的預后因素[J];腫瘤防治研究;2016年06期

4 王玉祥;王麗麗;楊瓊;李靜;何明;姚繼方;齊戰(zhàn);李寶重;喬學英;;pT3N0M0期胸段食管鱗癌胸腹兩野根治術后的復發(fā)模式[J];中華腫瘤雜志;2016年01期

5 Wanqing Chen;Rongshou Zheng;Hongmei Zeng;Siwei Zhang;Jie He;;Annual report on status of cancer in China, 2011[J];Chinese Journal of Cancer Research;2015年01期

6 解明然;梅新宇;李田;柳常青;孫效輝;張正華;馬冬春;;陰性淋巴結數(shù)目對無淋巴結轉移食管鱗癌患者預后的影響[J];中華胸心血管外科雜志;2014年04期

7 陳元美;陳俊強;朱坤壽;柳碩巖;陳曉輝;;淋巴結轉移數(shù)目與胸段食管鱗癌根治術預后關系[J];中華胸心血管外科雜志;2014年02期

8 林宇;陳俊強;李建成;劉健;朱坤壽;潘才住;陳明強;潘建基;;淋巴結陽性胸段食管鱗癌術后放化療的價值[J];中華腫瘤雜志;2014年02期

9 許茜;劉志坤;曹彥坤;李幼梅;祝淑釵;;食管癌大體腫瘤靶區(qū)體積與淋巴結轉移及預后的關系[J];中華腫瘤雜志;2012年09期

10 龐青松;章文成;王平;;胸段食管癌根治術后復發(fā)規(guī)律的臨床研究[J];中國腫瘤臨床;2012年16期

，

本文編號：1999868