Objective To analyze the prognostic factors for esophageal carcinoma patients with stump carcinoma and atypical hyperplasia after esophagectomy.Methods From August 2006 to December 2010,182 esophageal carcinoma patients with stump carcinoma and atypical hyperplasia after esophagectomy treated in our hospital were involved in this study,including 60 cases with grade Ⅰ-Ⅱ atypical hyperplasia,23 cases with grade Ⅲ atypical hyperplasia,37 cases with carcinoma in situ,and 62 cases with invasive carcinoma.Prognostic factors for these patients were analyzed.Results The 1-,2-,3-and 4-year locoregional control rates of these 182 patients were 77.1％,63.3％,60.3％ and 60.3％,respectively,and the over-all cumulative survival rates were 78.6％,63.9％,46.3％ and 41.0％,respectively.A total of 56 cases suffered from locoregional recurrence (56/182,30.8％),including anastomotic recurrence and lymph node metastasis.The number of locoregional recurrence patients of grade Ⅰ-Ⅱ of atypical hyperplasia was 13(13/60,21.7％),grade Ⅲ atypical hyperplasia and carcinoma in situ 21 (21/60,35.0％),and invasive carcinoma 22(22/62,35.5％).There were no significant differences among the three groups(x2 =3.485,P =0.175).There were significant differences in locoregional control rate and survival rate among the four treatment groups (P ＜ 0.05).For patients with stump grade Ⅰ ～ Ⅱ atypical hyperplasia and different stage positive stump margin,the 1-,2-,3-and 4-year survival rates of the four treatment groups had significant differences (P ＜ 0.05).As for locoregional control rates,there were no significant differences in the four groups (P ＞ 0.05).Univariate analysis showed that tumor length,depth of invasion,number of metastatic lymph nodes,number of lymph node metastatic fields,pTNM stage,stump pathological grade and treatment modality were main influencing factors for survival rate (P ＜ 0.05) ; invasion depth,stump pathological grade and treatment modality were important factors for locoregional control.Multivariate Cox regression analysis showed that tumor length,number of metastatic lymph nodes,stump pathological grade and treatment modality were independent influencing factors for survival (all P ＜ 0.05) ; invasion depth,stump pathological grade and treatment modality were independent influencing factors for locoregional control (all P ＜ 0.05).Conclusions For the patients with stump carcinoma and atypical hyperplasia after esophagectomy,tumor length,number of metastatic lymph nodes,stump pathological grade and treatment modality are independent influencing factors for long-term survival,and invasion depth,stump pathological grade and treatment modality are independent influencing factors for locoregional control.%目的 分析影响食管癌术后残端癌及残端不典型增生患者预后的相关因素.方法 2006年8月至2010年12月间行食管癌切除术、术后病理为残端癌及残端不典型增生的182例患者,其中残端不典型增生Ⅰ～Ⅱ级60例,残端不典型增生Ⅲ级23例,残端原位癌37例,残端浸润癌62例,对影响患者预后的临床病理因素进行分析.结果 182例患者的1、2、3、4年局部区域控制率分别为77.1％、63.3％、60.3％和60.3％,l、2、3、4年生存率分别为78.6％、63.9％、46.3％和41.0％.局部区域复发(包括吻合口复发和淋巴结转移)56例(30.8％),其中残端不典型增生Ⅰ～Ⅱ级组局部区域复发13例(13/60,21.7％),残端不典型增生Ⅲ级+原位癌组局部区域复发21例(21/60,35.0％),残端浸润癌组局部区域复发22例(22/62,35.5％),3组间差异无统计学意义(P =0.175).全组患者不同治疗方式的生存率和局部区域控制率差异有统计学意义(均P＜0.05).食管癌术后残端不典型增生Ⅰ～Ⅱ级和残端阳性不同病理分期患者的生存率差异有统计学意义(均P＜0.05),局部区域控制率差异无统计学意义(均P＞0.05).单因素分析显示,肿瘤长度、肿瘤浸润深度、淋巴结转移情况、淋巴结转移区域、肿瘤病理分期、残端病理分级和治疗方式与食管癌术后残端不典型增生及残端癌患者的生存率有关(均P ＜0.05),肿瘤浸润深度、残端病理分级和治疗方式与食管癌术后残端不典型增生及残端癌患者的局部区域控制率有关(均P ＜0.05).Cox多因素分析显示,肿瘤长度、淋巴结转移情况、残端病理分级和治疗方式为影响食管癌术后残端不典型增生及残端癌患者生存率的独立因素(均P＜0.05),肿瘤浸润深度、残端病理分级和治疗方式为影响食管癌术后残端不典型增生及残端癌患者局部区域控制率的独立因素(均P ＜0.05).结论 对于食管癌术后残端不典型增生及残端癌患者,肿瘤长度、淋巴结转移情况、残端病理分级和治疗方式是影响其长期生存的独立因素,肿瘤浸润深度、残端病理分级和治疗方式是影响其局部区域控制的独立因素.
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