發(fā)布時間：2018-06-27 20:38

  本文選題：食管鱗癌 + 食管癌手術(shù)��； 參考：《河北醫(yī)科大學》2017年碩士論文

【摘要】：目的:我國是食管癌高發(fā)國家,手術(shù)是食管癌治療的主要方式,但單純手術(shù)患者5年生存率僅在30%左右,術(shù)后放療、化療等輔助治療已成為改善患者預后的主要手段。NCCN(The National Comprehensive Cancer Network)制定的食管癌治療指南中指出食管癌術(shù)后淋巴結(jié)陽性的腺癌患者需行輔助放化療,而對食管鱗癌患者建議行術(shù)后放化療或觀察。眾所周知,我國食管原發(fā)性腺癌很少,90%以上類型為食管鱗癌,而且NCCN指南的研究對象大多為國外食管腺癌患者,所以其不能完全指導我國食管癌的治療。并且輔助性放化療對食管癌根治術(shù)后患者的治療效果,諸多學者的研究結(jié)果并不一致,仍存在眾多爭議。本研究主要對食管鱗癌術(shù)后淋巴結(jié)陽性患者行輔助化療的價值以及預后影響因素進行分析,以對如何預防食管癌術(shù)后復發(fā)及提高術(shù)后生存率進行進一步的探究。方法:本研究回顧性分析河北醫(yī)科大學第四醫(yī)院2008年1月至2012年2月284例食管鱗癌根治術(shù)后淋巴結(jié)陽性患者的資料。所有患者術(shù)前未行任何治療且無遠處轉(zhuǎn)移,術(shù)后病理均為原發(fā)性鱗狀細胞癌,且淋巴結(jié)陽性。本研究的預后相關(guān)因素包括性別、年齡、腫瘤位置、腫瘤長徑、淋巴結(jié)陽性數(shù)目(N分期)、腫瘤浸潤深度、腫瘤分化程度、淋巴結(jié)清掃數(shù)目、術(shù)后輔助化療、吸煙史、飲酒史等。以上資料使用SPSS21.0統(tǒng)計軟件進行統(tǒng)計學分析:應(yīng)用Kaplan-Meier生存曲線及Log-rank檢驗進行單因素生存分析,應(yīng)用Cox回歸法進行多因素生存分析。結(jié)果:隨訪截止至2017年3月,全組284例食管鱗癌術(shù)后淋巴結(jié)陽性患者3年、5年無病生存率(DFS)分別為28.9%,21%,中位值為15個月(范圍1~110個月)。單因素分析顯示:腫瘤長徑、淋巴結(jié)陽性數(shù)目(N分期)、腫瘤浸潤深度、腫瘤分化程度、術(shù)后輔助化療與DFS相關(guān)(P0.05);將腫瘤長徑、淋巴結(jié)陽性數(shù)目(N分期)、腫瘤浸潤深度、腫瘤分化程度、術(shù)后輔助化療納入Cox回歸多因素分析顯示:N分期(P=0.0000.05)、腫瘤浸潤深度(P=0.0070.05)、術(shù)后輔助化療(P=0.0070.05)是影響食管鱗癌術(shù)后淋巴結(jié)陽性患者DFS的獨立預后因素。全組284例食管鱗癌術(shù)后淋巴結(jié)陽性患者3年、5年總生存率(OS)分別為35.2%,23.9%,中位值為23個月(范圍1~110個月);單因素分析顯示:腫瘤長徑、淋巴結(jié)陽性數(shù)目(N分期)、腫瘤浸潤深度、腫瘤分化程度、術(shù)后輔助化療與OS相關(guān)(P0.05);將腫瘤長徑、淋巴結(jié)陽性數(shù)目(N分期)、腫瘤浸潤深度、腫瘤分化程度、術(shù)后輔助化療納入Cox回歸多因素分析顯示:N分期(P=0.0000.05)、腫瘤浸潤深度(P=0.0170.05)、術(shù)后輔助化療(P=0.0010.05)是影響食管鱗癌術(shù)后淋巴結(jié)陽性患者OS的獨立預后因素。其中119例術(shù)后輔助化療患者中,化療方案的差異與食管鱗癌術(shù)后淋巴結(jié)陽性患者DFS(P=0.490.05)、OS(P=0.6560.05)無明顯相關(guān)。結(jié)論:1食管鱗癌術(shù)后淋巴結(jié)陽性患者手術(shù)效果欠佳,預后較差,術(shù)后N分期是影響食管鱗癌術(shù)后淋巴結(jié)陽性患者DFS、OS的獨立預后因素。并且隨著淋巴結(jié)陽性個數(shù)的增加,生存率逐漸下降。2腫瘤浸潤深度是影響食管鱗癌術(shù)后淋巴結(jié)陽性患者DFS、OS的獨立預后因素。并且隨著腫瘤浸潤深度的增加,患者的預后越差。3術(shù)后輔助化療是影響食管鱗癌術(shù)后淋巴結(jié)陽性患者DFS、OS的獨立預后因素,可以提高患者的DFS及OS,所以建議食管鱗癌術(shù)后淋巴結(jié)陽性患者行輔助化療。4不同的輔助化療方案對食管鱗癌術(shù)后淋巴結(jié)陽性患者生存差異無統(tǒng)計學意義,仍需大樣本量進行深入的探究。
[Abstract]:Objective: China is a country with high incidence of esophageal cancer. Surgery is the main treatment for esophageal cancer, but the 5 year survival rate of patients with simple surgery is only about 30%. Adjuvant therapy, such as postoperative radiotherapy and chemotherapy, has become the main means to improve the prognosis of patients with.NCCN (The National Comprehensive Cancer Network) in the esophagus cancer treatment guide. It is well known that there are few primary adenocarcinoma in our esophagus and more than 90% of the types of esophageal squamous cell carcinoma in our country, and most of the subjects of the NCCN guide are foreign food tube adenocarcinoma patients, so it can not guide our food completely. There are many controversies in the treatment of carcinoma of tube and adjuvant chemotherapy for patients with esophageal cancer after radical resection of esophagus cancer. There are still many disputes. This study is mainly about the value of adjuvant chemotherapy and prognostic factors in the lymph node positive patients after esophageal squamous cell carcinoma, in order to prevent the esophagus cancer after operation. A retrospective analysis of 284 cases of lymph node positive patients after radical resection of esophageal squamous cell carcinoma from January 2008 to February 2012 in fourth hospital of Hebei Medical University was analyzed retrospectively. All patients had no treatment before operation and no distant metastasis, and the postoperative pathology was primary squamous cell carcinoma. The prognostic factors of this study included gender, age, tumor location, tumor length, lymph node positive number (N staging), tumor infiltration depth, tumor differentiation, lymph node dissection, postoperative adjuvant chemotherapy, smoking history, and drinking history. The above data were statistically analyzed using the SPSS21.0 software: application of Kapl An-Meier survival curve and Log-rank test were used for single factor survival analysis and multiple factor survival analysis by Cox regression. Results: 284 cases of squamous cell carcinoma of the esophagus were followed up to March 2017. The 5 year disease free survival rate (DFS) was 28.9%, 21%, and the median value was 15 months (1~110 months). The long diameter of tumor, the positive number of lymph nodes (N staging), the depth of tumor invasion, the degree of tumor differentiation, the correlation of postoperative adjuvant chemotherapy and DFS (P0.05), the length of the tumor, the positive number of lymph nodes (N staging), the depth of the tumor, the degree of differentiation of the tumor, and the postoperative adjuvant chemotherapy in the Cox regression analysis showed that N staging (P=0.0000.05), and tumor soaked. P=0.0070.05, postoperative adjuvant chemotherapy (P=0.0070.05) was an independent prognostic factor for DFS in patients with positive lymph nodes after esophageal squamous cell carcinoma. 284 cases of lymph node positive after esophageal squamous cell carcinoma were 3 years after operation, and the total 5 year survival rate (OS) was 35.2% and 23.9% respectively. The median value was 23 months (1~110 months), and the single factor analysis showed the tumor length, Lymph node positive number (N staging), tumor invasion depth, tumor differentiation degree, postoperative adjuvant chemotherapy and OS correlation (P0.05); tumor length, lymph node positive number (N staging), tumor invasion depth, tumor differentiation degree, postoperative adjuvant chemotherapy into Cox regression multivariate analysis showed: N staging (P=0.0000.05), tumor infiltration depth (P=0.0170.05), Postoperative adjuvant chemotherapy (P=0.0010.05) was an independent prognostic factor affecting OS in patients with positive lymph node metastasis of esophageal squamous cell carcinoma. Among 119 patients with postoperative adjuvant chemotherapy, there was no significant correlation between chemotherapy regimens and DFS (P=0.490.05) and OS (P=0.6560.05) of lymph node positive patients after esophageal squamous cell carcinoma. Conclusion: 1 lymph node positive after operation of squamous cell carcinoma of the esophagus The results were poor and the prognosis was poor. N staging was an independent prognostic factor of DFS and OS in patients with positive lymph nodes after operation. And with the increase of positive lymph node number, the survival rate decreased gradually and the depth of.2 tumor infiltration was the independent prognostic factor of DFS and OS in lymph node positive patients after esophageal squamous cell carcinoma. The worse the depth of tumor infiltration, the worse the prognosis of patients with.3 postoperative adjuvant chemotherapy is an independent prognostic factor of DFS, OS and DFS and OS in patients with positive lymph nodes after operation of esophageal squamous cell carcinoma. Therefore, it is suggested that the postoperative lymph node positive patients with esophageal squamous cell carcinoma undergo adjuvant chemotherapy with different adjuvant chemotherapy regimens for postoperative lymph nodes of esophageal squamous cell carcinoma The survival of positive patients was not statistically significant, and large sample sizes still need to be explored in depth.
【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(guān)期刊論文 前10條

1 陳萬青;鄭榮壽;曾紅梅;鄒小農(nóng);張思維;赫捷;;2011年中國惡性腫瘤發(fā)病和死亡分析[J];中國腫瘤;2015年01期

2 湯薩;黃佳;董金城;袁果;李燕;張朋;宋昕;趙學科;范宗民;雷茜琳;王立東;;性別對高、低發(fā)區(qū)食管癌患者生存期的影響[J];腫瘤防治研究;2014年03期

3 崔紀麗;侯志超;劉玉;彭秀青;李燕;郭二濤;袁果;陳莉莎;黃佳;杜丹鳳;王立東;;食管癌患者腫瘤最長徑與浸潤深度和淋巴結(jié)轉(zhuǎn)移的關(guān)系及其對生存期的影響[J];腫瘤防治研究;2014年03期

4 陳萬青;張思維;曾紅梅;鄭榮壽;鄒小農(nóng);趙平;吳良有;李光琳;赫捷;;中國2010年惡性腫瘤發(fā)病與死亡[J];中國腫瘤;2014年01期

5 王海龍;穆宏鑫;;40歲以下食管癌86例術(shù)后生存分析[J];寧夏醫(yī)學雜志;2013年10期

6 陳硯凝;劉月平;張玲玲;劉彩虹;王小玲;;食管鱗狀細胞癌預后的多因素分析[J];中華腫瘤防治雜志;2013年14期

7 何健;王杰軍;錢建新;甘露;張霞;焦曉棟;柳珂;;第6版和第7版UICC-AJCCTNM分期系統(tǒng)預測食管癌根治性切除術(shù)后生存情況的比較:基于400例食管癌患者的臨床分析[J];腫瘤;2013年02期

8 趙登平;張社軍;李民華;;三維適形放療聯(lián)合化療治療食管癌術(shù)后縱隔淋巴結(jié)轉(zhuǎn)移的臨床療效觀察[J];海南醫(yī)學;2013年04期

9 朱青山;申靜;趙世杰;何志杰;張慶富;馮連杰;;食管癌同步放化療的臨床研究[J];中國腫瘤臨床與康復;2012年03期

10 祝淑釵;宋長亮;沈文斌;蘇景偉;李娟;劉志坤;;食管癌根治性切除術(shù)后患者預后的影響因素分析[J];中華腫瘤雜志;2012年04期

相關(guān)碩士學位論文 前4條

1 李國棟;1510例食管癌患者術(shù)后生存率及預后影響因素分析[D];山西醫(yī)科大學;2016年

2 趙妍;河南省食管癌根治術(shù)后患者預后相關(guān)因素分析[D];鄭州大學;2015年

3 楊瓊;Ⅲ期食管癌根治術(shù)后的療效及復發(fā)模式[D];河北醫(yī)科大學;2015年

4 王藝;復發(fā)轉(zhuǎn)移性食管癌患者預后因素分析[D];山東大學;2013年

，

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