本文選題：食管癌 + 根治性手術(shù)　； 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討非手術(shù)食管癌的臨床分期標(biāo)準(zhǔn)(草案)【1】與根據(jù)第8版AJCC/UICC食管癌TNM分期標(biāo)準(zhǔn)進行的術(shù)后病理分期的一致性及兩種分期標(biāo)準(zhǔn)對食管癌患者預(yù)后判斷的臨床價值。并探討食管癌根治術(shù)后相關(guān)預(yù)后因素。方法:回顧分析2012年6月至2016年10月在我院行食管癌根治性手術(shù)患者的臨床資料,并通過電話進行隨訪。根據(jù)患者術(shù)前CT及鋇餐等,采用非手術(shù)治療食管癌的臨床分期標(biāo)準(zhǔn)(草案)行術(shù)前分期,根據(jù)術(shù)后病理結(jié)果,運用第8版AJCC/UICC食管癌TNM分期標(biāo)準(zhǔn)行術(shù)后分期。采用Kappa法檢驗兩種分期標(biāo)準(zhǔn)的各期患者分布一致性,并采用Kaplan-Meier法對兩種分期各T、N及TNM分期進行生存分析。對可能影響食管癌根治術(shù)后患者的預(yù)后因素進行單因素及多因素分析。結(jié)果:(1)本研究共入組148例患者。中位生存期為25個月(1-54個月)。1、2、3年生存率為82.0%、51.2%、20.5%。(2)術(shù)前分期與術(shù)后分期符合情況:104例患者T分期相符,符合率70.3%,Kappa值0.528,一致性中等;100例患者N分期相符,符合率67.6%,Kappa值0.470,一致性中等;90例患者TNM分期相符,符合率60.8%,Kappa值0.402,一致性中等。(3)兩種分期標(biāo)準(zhǔn)的T、N及TNM分期的生存曲線均能較好分開,對預(yù)后判斷有預(yù)示作用。(4)多因素分析顯示年齡、UICC T分期、腫瘤部位、病理類型、分化程度、淋巴結(jié)轉(zhuǎn)移、飲酒史為食管癌根治術(shù)后患者獨立危險因素。結(jié)論:非手術(shù)食管癌臨床分期(草案)與術(shù)后分期一致性中等,并且能夠?qū)⒏鞣制谏媲�分開,是值得進一步研究的食管癌臨床分期方法。年齡、腫瘤部位、UICC T分期、病理類型、淋巴結(jié)轉(zhuǎn)移、飲酒史是食管癌根治性手術(shù)的獨立預(yù)后因素,對于預(yù)后有較好判斷作用。
[Abstract]:Objective: to investigate the consistency between the clinical staging criteria (draft) of non-operative esophageal carcinoma (draft) and the postoperative pathological staging according to the 8th edition of AJCC / UICC TNM staging standard for esophageal carcinoma and the clinical value of the two staging criteria in judging the prognosis of esophageal cancer patients. To explore the prognostic factors after radical resection of esophageal carcinoma. Methods: the clinical data of patients undergoing radical esophageal cancer surgery from June 2012 to October 2016 were retrospectively analyzed and followed up by telephone. According to the preoperative CT and barium meal, the clinical staging standard (draft) for non-operative treatment of esophageal carcinoma was used. According to the postoperative pathological results, the 8th edition of AJCC / UICC TNM staging standard was used for postoperative staging of esophageal carcinoma. Kappa method was used to test the consistency of distribution between the two stages, and Kaplan-Meier method was used to analyze the survival of the two stages. Univariate and multivariate analysis was performed on the prognostic factors of patients with esophageal cancer after radical resection. Results: (1) 148 patients were enrolled in this study. The median survival time was 25 months (1-54 months). The 3-year survival rate was 82.0 and 51.2 and 20.5. (2) the preoperative and postoperative stages were consistent with T staging in 10 ~ 104 patients. The coincidence rate of Kappa was 0.470, and 90 patients with moderate consistency were consistent with TNM staging. The coincidence rate was 60.8 and 0.402, respectively. (3) the survival curves of TN and TNM stages of the two staging criteria could be well separated. (4) multivariate analysis showed that age UICC T stage, tumor location, pathological type, differentiation degree, lymph node metastasis and drinking history were independent risk factors for patients with esophageal cancer after radical operation. Conclusion: the clinical stage (draft) of non-operative esophageal carcinoma is of moderate consistency with postoperative stage and can separate the survival curve of each stage. It is a clinical staging method worthy of further study. Age, tumor location, UICC T stage, pathological type, lymph node metastasis and drinking history were independent prognostic factors for radical operation of esophageal carcinoma.
【學(xué)位授予單位】：廣西醫(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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